THE VIOLATION OF VICKI WILSONS HUMAN RIGHTS MAY 2023

Comments most of which emanate from an Asian short wave station are contained in a separate addendum at the conclusion of this complaint

PROBABLE THEFT
EXTRACTS FROM AN ASIAN INTERNET CHANNEL PERTAINING TO WHAT WOULD APPEAR PERSONAL EFFECTS APPARENTLY STOLEN IN WHANGAREI ARE DETAILED BELOW:
My brother Bruce Wilson and I sold our family home in 59 Devore St in 2014. Because there was a delay in moving into a rented home in 62 West View Crescent Whangarei my furnishings went into storage at AA Auckland Carriers for 2 weeks prior to their transfer to Whangarei.. AA Auckland Carriers have storage facilities in Henderson Auckland. The Director of the company was a middle eastern man. Our possessions were in a mixture of small and large boxes. Everything seemed to be in order when the boxes were delivered in May 2014 to West View Crescent Onerahi Whangarei by 2 Maori men from AA carriers with the exception of the fridge which contained urine! Bruce stayed with me for a week or two then departed for the US. I don’t recall that I had any significant absences at that time. Most of the boxes remained in the lounge with the top of the boxes opened but unpacked.
Records and CDs also seemed to be in order and were retained in my record cabinet. In late November 2017 I presided over the transfer of the personal effects from West View to 2 units at the Whangarei Storage Centre Raumanga which were subsequently reduced to one unit. Some pieces of furniture were sold in later years. Remaining personal effects are still retained in Raumanga. Some furniture was transferred to my new accommodation a unit at 18 Sherwood Road Onerahi where I remained from from December 2017 until February 2020. I then transferred to a Haumaru Housing unit at Takapuna Auckland. Items such as books and pictures and decorative items remained in storage.
I would have thought it unlikely that any pilfering would have taken place from storage my unit in Raumanga there isn’t much room to manoeuvre as the boxes are large and heavy ant the ground is covered with large stones and gravel The unit also had a lock for most( not all) of the time that the effects have been in storage. I recently spoke to one of the women who run the office and denied the likelihood of a break-in there. The only occasions when a break- could have occurred would be in storage at Auckland Carriers or from my rented home at West View Crescent. There were 2 occasions when I attended afternoon specialist consultations in Auckland and would have been absent most of the day. I do recall a middle aged man who parked outside my kitchen window in Sherwood Road Whangarei. He had a large metal box in the boot which he had opened. He was possibly a locksmith. He departed after about 5 minutes.
If that was the case then the relatives could have had the assistance of Barfoots rental agent Ms Kahlin Cook (Russian ring?) who did regular inspections of my unit in West View. It had been said that see that Ms Cook may have left Barfoots as a result of petty theft. That aspect would need to be clarified. She certainly left suddenly and went to Australia. Öther rental staff seemed to be somewhat evasive “pastures new” was the only explanation I received. I overheard a comment from a young male teenager in Cameron Street Whangarei that “Kahlin had told lies to the police”. Then there are the odd comments from 2 men both possibly police officers in Auckland -the one “where did I find a Karcher” ( it is still in my storage unit) and the young man who “has a silver kodak camera with scenes in it” which I last recall as being in my possession in my former home in West View Crescent where there were views over the water and mangroves.

References to some of my personal possessions supposedly still in storage: -books and records :“ under the bunyip tree”//Doreen Kelsos handy hints///Gregorian chants ( a rare set of records)///Troilus and cresseide ( university medieval english book)//Voltaire////Griswalds ( a comedy video) the firemans story (video of firemen inside twin towers 9/11)///////Maureen has shells and dolls( I had a collection of miniature dolls and polished shells)///this latest is “devil may care” (track of a jazz cd from Diana Krall////st germaine ( jazz cd)///Miss Kassler is reading “the snow goose”( small slim book with a blue paper cover)////this latest is nightfallers (80s record)”(-in addition a ruby glass vase went missing from my unit in Whangarei) ////“I have a silver kodak camera which contains scenes”-formerly in my possession in Whangarei ( young man poss police officer///Mrs Simichs psy-chiatrist went through all Vickis books ///// Mossad said it’s a china bear ( poss ref to a piece of fine china formerly in my possession) Mossad dis-covered Royal Doulton “Mrs Simich is not an existentialist” ( poss ref to another university book by philospher J Paul Sartre////Caroline discovered a Toby jug//// why we stole the stuff( Kassler niece?/////Israelis has the firemens video-( doubleday video of 9/11) /// /the latest is “Enya” (80s LP// Mrs Simich said these are better personal effects///// where did I find a Karcher – Wilson( ( male police officer?)(-a Karcher water blaster was one item among my personal effects in storage in whangarei/)/ Bruce said Elegance magazines with Maureen ( formerly in my collection)// Mo Kassler had medals and coins ( poss Alan Wilsons collection -my personal effects)/ Bruce gave your books to the cousins//// It’s the owl/contained plutonium/way Miss Kassler contaminated ( small wooden owl sent to us by M Kassler from London)/// Ann Simich says bizzie will lose everything//// this is Kassler discussing burglaries//// why Miss Kassler has her books ( Kassler niece/// Mossad discovered Royal Doulton/// Mary Anne(Wilson)? has brass(assorted brass items including a table in storage)///// why Miss Kassler has her books ( Kassler niece/// taken Vickis papers from Ann Simich/// knitting books in background///( my mother left behind a number of knitting books-among my possessions in whangarei)) Bruce gave your books to the cousins // Melitia keeps walking past the storage unit in Raumanga// Ann Simich found a tapestry in a family unit ( There was an unfinished tapestry in my stor-age unit in whangarei)///Mrs Simich said your mother had lovely crystal/// M Kassler thinks Vicki sold the breastplate ( not that I am aware!) /////Mossad has details of Vickis painting/// Clem Simich stole vickis boxes/////Its Halston in Mo Kasslers cupboard? ( poss ref to a Halston jacket I purchased at a sale at Smith and Caugheys many years ago)// some of Vickis stuff in the home of Ashburn staff member/////M Kassler has one of Vick-is chemistry books/////////
For the last few years I have been a tenant at a Haumaru Housing complex in Takapuna. I am the only New Zealander amongst the group of tenants -the majority are of Russian//Bulgarian and Asian origin with the exception of 2 male British tenants. They seem to be going to great lengths to effect my removal with false complaints. I have often been subjected to obnoxious comments including one Russian man who has GRU affliliations and has threatened to get rid of me. He apparently has a police history here and in Sydney Australia where he was a suspect in the death of a young woman he had been escorting -she was found dead floating under the bridge! Another female tenant with middle eastern contacts attempted to destroy her child and served 3 months in jail.
The discrimination about which I have complained has occurred as a result of collusion between my former employer , the police the medical, psychiatric, and legal professions together with the general public, which was further exacerbated by the wrongful incarceration in a mental institution.. The situation subsequently deteriorated into a sinister case of psychiatric/psychological “black ops “and experimentation.”
LEGAL/GOVERNMENT/ CONTACTS
At a meeting with criminal barrister Mr Tomlinson in 2004 he stared rather fixedly during the consultation and repeatedly advised that he was unable to assist.I n July 2005 the former assistant to the President of the Auckland District Law society Miss Malcolm advised “that none of my concerns could be considered a legal matter”Miss Malcolm subsequently became assistant to the National Party’s former Minister of Justice Whereas in previous years although I did not receive any offers of assistance from senior members of the legal profession , I did at least receive the courtesy of a reply. There were difficulties in obtaining legal assistance in respect of both my Human Rights complaint and also family trust matters.
I In response to my complaint to the Minister of Justice Amy Adams I received a reply from Swati Bhim Private Secretary Justice and Courts dated 23 April 2015 He advised that “the Minister of Justice ….has asked me to thank you for your correspondence regarding your concerns. Please be assured that your correspondence …has been noted by this office. Thank you for keeping the Minister informed” It isn’t entirely clear how my complaint to Mrs Adams was handled by Swati Bhim.
A complaint to Chief NZ Human Rights Commissioner David Rutherford dated 30 March 2015 resulted in no reply. In a subsequent response to my complaint to the Human Rights Commission Mediator Sue Smith stated in her letter dated 4 September 2015 that “ the commission will not take any further action on it because the matters you describe do not meet the required criteria for a complaint of unlawful discrimination”
Two criteria specified by the commission are “ happened in an area of public life such as government activity” and “ disability –(apartheid as a result of previous employment and (inappropriate) psychiatric treatment) might be deemed most pertinent and not to be disregarded. Once again assistance has been denied.Two attempts to involve a Queens Counsel Paul Davison and and barrister Mr Dan Gardiner both of whom specialise in criminal law and other senior members of the legal profession either elicited no response or rejection. Davison’s secretary advised that he had other commitments. (My email had initially been consigned to spam!) A further attempt to contact Davison in December 2014 resulted in no response.. There was no response at all from Gardiner.
Other prominent members of the legal fraternity who were also unable to assist were Anthony Rogers (barrister), Mr R Stewart (QC), Justice Asher ( formerly QC), J Billington (QC), G Illingworth(QC), Colin Pidgeon (QC) J Anderson ( barrister), RB Stewart (QC) criminal lawyers Annabel Ives and Karen Harding and J Haigh (QC). In 2010 Barrister Graeme Newell responded ‘that he hadn’t opened the attachment because he didn’t know what it was” and in September 2016 Mr J Corby Barrister of Auckland failed to reply .There was no assistance offered from either David Neutze of Brookfields or Shane Tait. He was otherwise engaged and although he advised that he would return my phone call failed to do so. There was no response from criminal lawyer Mr Fairley of Thomson Wilson Law Whangarei in February and March 2016 nor from Dr Henderson of Henderson Reeves in May 2016. A follow up query with Mr Reeves in November 2017 and 2018 was also ignored.

In September 2017 Ms E Priest of Blackstone Chambers Auckland advised “ It sounds like you have had a terrible time. It sounds like you are seeking compensation? I’m afraid I cannot take on your case as I am simply too busy. I am also purely a criminal barrister. It sounds like you need a civil lawyer with medico-legal experience . There was no response from Gerard McCoy QC (deceased) of the same practice In March 2018 Mr Eaton QC advised that “ he was unable to assist in this matter In February 2019 Barrister Ron Mansfield replied “Vicki, Thank you for your email. I did receive your email on 7 January 2019 while I was on leave. I am not sure what you require or how I might assist. I am also very busy at the moment and lack capacity to assist, if it is urgent. Kind regards, Ron Mansfield. Further attempts on 29 June and 5 December 2022 were ignored. In May 2019 Mr Clarke senior partner of Bell Gully rejected my complaint . There were four emailed complaints to Mr Dacre QC over a 2 year period and also a brief phone conversation with Mr Dacre in March 2022. He was unable to assist. There was a similar lack of response from Paul Wicks QC on 29 June 2022 and criminal lawyer J Munro .
In 2009 a senior lawyer Mr J Kirkby of Remuera charged us $1800.00 for compiling and perusing trust documents the compilation and assessment of which probably wouldn’t have taken more than a couple of hours. Another Remuera solicitor Mr Ellis who was about my age suggested that I might like to see a younger man as he was near retirement. He also quoted a rather exorbitant amount for the resettling of a trust . As of January 2013 he still practicing law.
A routine enquiry to Mr Duncan of Fortune Manning resulted in a delayed reply of almost 2 weeks as my enquiry had apparently been put into junk mail,
Comments some of which pertain to trust matters have included “ watch revolting” from a retired corporate lawyer (Mr G Jones of Orakei,) — “ get rid of her” (Mr Taylor of Galbraiths of Howick), and “committed” ( Harold Kidd of Glenfield )—- “ smells a bit //pain in the ass /breathing down the neck” from Barry Hopkins of Auckland city and “there has to be a subsidy drama” –ultrasonic comment (Mr Walter Graham of Mt Eden) .–“ your email doesn’t appear to have surfaced” ( Mahon and Sumpter on the North shore)- “ Israelis say its mental derangement”/Its Maureen” (partners John Armstrong and Neil Murray of Takapuna). Graeme Newell responded ‘that he hadn’t opened the attachment because he didn’t know what it was”
A comment from lawyer Mr Howard Smith suggested that both my brother and I might predecease our elderly mother! When I enquired as to the hourly rate of senior partner Mr R Craig he replied “ what is yours”! ”. There have also been derogatory comments in the past from local lawyers including Mr Callaghan and his wife, and an “ arrested” comment from Mr Bone. Mr Stephen Anderson advised that he was “ overcommitted” and Mrs Wood of Patterson Hopkins suggested that “you could put the trust documents into the bank and then send them on to us”
In 2013 I first arranged an appointment at 11.00 the following day with the wife of lawyer Gavin Cocroft . Mr Cocroft advised me by phone that he needed to change the appointment time to 1 pm on the same day.
When I visited their home at 1 pm I could see Mr Cockroft in the lounge. A womans voice could be heard inside the house saying “ you are not wanted here”. The dog was barking loudly at the front door- Cockroft called the dog away from the door but did not attempt to open it. I departed. I subsequently received an email from the gentleman advising that “I am sincerely sorry for your wasted trip yesterday. I have been having problems with blocked ears, which have severely affected my hearing, and am seeing the doctor today. Also, I found out only yesterday afternoon that our front door bell was not working, and I was listening for that. I did come out to the front about 11 but obviously missed seeing you”! (My deceased mother was deaf!)
.Murray Kirkness the Editor of the NZ Herald failed to reply to my emailed complaint in August 2016. There was no further communication from Stuart Dye Deputy Editor of the NZ Herald in February 2018 nor reporters K Johnston and J Savage in May 2018.
In his letter dated 23 april 2013 Mr Ilott advised “that the Ombudsman would exercise his discretion not to take your concerns any further”
The following are extracts from correspondence between myself and the Office of the Ombudsman from 4 July 2018 until 10 October 2018.
‘The underlying concern in my complaint was that of discrimination or apartheid and any probable negligent consequences. I am not requesting the Ombudsman’s review of Health and Disability’s decision. If complainants are not satisfied with the response they receive from one investigative body then they should be entitled to obtain another alternative opinion including from the Office of the Ombudsman
Scott Martin Acting Manager – Intake and Early Assistance Team advised:
‘The Ombudsman is not an appeal body, empowered to exercise the functions of the original decision maker, but considers whether the decision maker acted in a lawful and administratively reasonable manner regarding the relevant decision or action. I must advise that an Ombudsman does not have the authority to consider complaints about the standard of service provided by a health provider. This is the role of the Health and Disability Commissioner (HDC) under the Health and Disability Commissioner Act 1994.It may assist you to explain that an Ombudsman does have the authority to consider complaints about HDC. However, I must advise that this jurisdiction is limited, and an Ombudsman does not review HDC’s professional judgement about a complaint.
You have raised concerns about the assessment of your complaint by the Health and Disability Commissioner (HDC). You state that you are not seeking that an Ombudsman review HDC’s decision on your complaint, but that an Ombudsman provide ‘another alternative opinion.’ As previously explained, an Ombudsman has no authority to consider complaints or form opinions about the standard of service provided by a health provider . This is the role of the HDC.
You have noted that District Health Boards (DHBs) are subject to the Ombudsmen Act 1975, and therefore are within an Ombudsman’s jurisdiction. However, I must emphasize that an Ombudsman can only consider complaints about administrative acts or decisions of District Health Boards. Concerns about any health service provided by an organisation operated by a DHB remains a matter for HDC.
I should also reiterate that, if you have any concerns, in an administrative sense, about HDC’s consideration of your 2007 complaint, or your 2009 request for your complaint to be reopened, then you would need to outline clearly what these concerns are, and explain the reasons for your delay in approaching this Office
If you wish to pursue this matter further, then I suggest that you discuss your concerns with a lawyer. You can contact your local Community Law Centre for free legal assistance. ”
There does seem to be some overlap with regard to investigative procedures of the Ombudsman’s office and Health and Disability. Perhaps the only difference is that H & D are acting in accordance with a code of rights, In the case of incarcerated mental patient Ashley Peacock a complaint was responded to by the Ombudsman’s office as opposed to Health and Disability. ( There was no reference to the Peacock case in the replies from Scott Martin) . In your letter you advised that “ an Ombudsman does not have the authority to consider complaints about the standard of service provided by a health provider. This is the role of the Health and Disability Commissioner- but considers whether the decision maker acted in a lawful and administratively reasonable manner”. The latter statement would by implication involve an assessment of “the standard of service provided by a health provider”
You further advise that “ Ombudsman has the authority to investigate complaints about the administrative actions and decisions of the central and local government agencies listed in the Ombudsman Act. This does seem to contradict your statement concerning health providers in the previous paragraph. Local government agencies include District Health Boards who in turn have oversight over their Primary Health Organisations (PHOs)/ general practices.
Unfortunately you ignored a significant part of my complaint pertaining to the last 10 years. I have attempted to obtain assistance from a number of lawyers over the years but my complaint including mental health issues has been generally ignored including District Inspectors of Mental Health. .
On 13 December 2018 an email was onforwarded to PM Jacinda Ardern:
“Dear Prime Minister,
Please find enclosed two complaints pertaining to human rights. One complaint is abbreviated including some images and the while the other is a much lengthier version .An additional attachment sent under cover of a separate email contains files.. The level of discrimination in my case would seem to be unprecedented and unlikely to occur in any other country in the western world . Compensation/damages should be a consideration.
Acknowledgment of the receipt of this email would be appreciated.
Yours sincerely, Vicki Wilson”
On 17 December 2018 Dinah Okeby of the Prime Minister’s office advised : “Many thanks for your emails to the Prime Minister Jacinda Ardern. I have passed your emails to the Minister of Justice Hon Andrew Little for his information” On 14 December 2019 a subsequent email was sent to the Prime Minister The Rt Hon Jacinda Ardern. Apart from an automatic response there was no further reply.
On February 2019 Barrister Ron Mansfield stated: “I am not sure what you require or how I might assist. I am also very busy at the moment and lack capacity to assist, if it is urgent.” A second attempt on 11 June 2020 was ignored. In May 2019 Mr Clarke senior partner of Bell Gully rejected my complaint.
On 21 February 2019 I make an enquiry at the office of the Minister of Justice :
The Minister of Justice The Hon. Andrew Little
“Dear Minister,
My lengthy email and attachments dated 17 December 2018 onforwarded to you from the office of the Prime Minister the Hon. Jacinda Ardern refer.An acknowledgment of the receipt of same and/or a reply would be appreciated. Copies of the emails are detailed below. There was no reply.
My complaint to National MP the Hon Gerry Brownlee in August 2019 was ignored.
Complaints were also emailed to M Laracy Inspector of Security and Intelligence on 19 March 2020 and an unsigned reply dated 23 March is as follows:
“Kia ora Ms Wilson
Thank you for your correspondence.
The Inspector-General is able to investigate complaints from a New Zealand citizen or a person ordinarily resident in New Zealand who has, or may have, been adversely affected by an act, omission, practice, policy, or procedure of the New Zealand Security Intelligence Service (NZSIS) or the Government Communications Security Bureau (GCSB). The matters raised in the material you have sent to my office do not relate to the activities of the GCSB or NZSIS. As a consequence, the Inspector-General does not have jurisdiction to investigate the matters you have raised. To the extent that the matters you raise relate to electronic and/or electro-magnetic activities, we are able to inform you that the Director-General of the NZSIS has previously informed the Inspector-General that the NZSIS does not use or deploy any electro-magnetic harassment technologies.??This will not have been the response you were hoping for but we trust that this advice from the Service is able to provide you with a small measure of reassurance.
Regards
M Laracy Inspector General of Security and Intelligence
Murray Kirkness the Editor of the NZ Herald failed to reply to my emailed complaint in August 2016. There was no further communication from Stuart Dye Deputy Editor of the NZ Herald in February 2018 nor reporters K Johnston and J Savage in May 2018. A further complaint to Emma Russell Health Reporter on 5 April 2021 was ignored.
MEDICAL DISCRIMINATION:
Some of the more blatant examples of medical discrimination are detailed below: Widdles all the time ( Dr Mpe respiratory physician)///why you have been sacrificed ( blond female senior staff member Whangarei Hospital)///getting rid ((Scottish radiographer Auckland Radiology) /////the failure of prominent gynaecologist Dr Liggins to pursue a further investigation-an erroneous initial diagnosis)/// the lack of advice concerning an unspecified object found as a result of hysterectomy and oophorectomy at Mercy Hospital in 1988.//////The director of this hospital doesn’t like you visiting -you like cats! (unknown male staff member and Dr Richard Fisher while my mother and I were standing in the lobby of Ascot Hospital)/////delusional about infection throughout the whole body (subheading on a report from Dr Dev Tandon -ENT specialist)////committed ( Dr Van Roekel St Heliers practice///Clem says its behavioural problems ( Dr Ted Clarke Cardiologist)////Incarceration of people they didn’t know what to do with into a mental hospital with ( Dr Tasman Jones)/////)///Nutter ( Dr Roblin Onerahi practice Whangarei)//lunacy ( Dr Gordon orthopaedic specialist doesn’t like f…king ( Dr Anderson A&E clinic Kohimarama)////the failure to adequately diagnose or treat erythema palma and nodosum in the early 1980s. Comments on the internet include : medics used ladies from the line///Israel had a list of experimental children// Vicki Wilson was on an experimental list///
MEDICAL / POLITICAL CONTACTS
In November 2012 my complaint was onforwarded to the Associate Minister of Health Mr Peter Dunne. A reply from his staff member A Portis recommended contact with both the Obmudsman and the District Inspector of Mental Health. In his letter dated 23 april 2013 Mr Ilott advised “that the Ombudsman would exercise his discretion not to take your concerns any further”
An emailed complaint to the former associate minister of Health Joe Goodhew in August 2014 was not replied to . In his letter dated 27 April 2016 the Minister of Health the Hon Dr Jonathon Coleman advised “It is not appropriate for me as Minister of Health to intervene in the delivery of health care to individual patients . You should make your complaint to the provider of the services in the first instance”
On 22 February 2018 I onforwarded an email to Dr Roberts Chief Medical officer of Health for Whangarei expressing my concerns about respiratory, manmography neurology, cardiology, matters and a local general practitioner Dr Detjen.. In his reply dated 22 March Dr Roberts advised “I did not reply to your earlier mail because there did not appear to be a question for me to address. It seemed simply to pass on a considerable amount of information about your past medical care . Having reread that email today I remain unclear of your reason for contacting me. I would be most grateful for your advice in this regard.”
My reply dated 2 April 2018 stated “I would have thought it obvious that the general nature of my email was that of a complaint which was sent to you in the hope you might be able to rectify some of these issues.” The complaint was also onforwarded to NDHB CEO Dr Chamberlain on 13 April 2018 and was in turn onforwarded to Quality and Control and finally the General Manager, Medicine, Health of Older People, Emergency and Clinical Support Mr Beney. On 30 April he advised “ due to the number of services involved it is taking time to get the required information to respond to your concerns” There has been no further communication from Mr Beney.
A reply was eventually received from Mr Beney dated 28 October 2018. He referred to “ your email and attachments which were received by Dr Bradley on 18 September 2018-as you raised a concern that was outside of her area Dr Bradley forwarded your email on so a coordinated approach to your response could be provided. Dr Bradley declined the request for a clinic review and reinforces that there is no evidence for bronchiectasis. (“ very minor right lower lobe bronchiectasis” was reported in an ADHB CT scan of 2011) “ The nodule has been under surveillance for well beyond the recommended timeframe. She does not believe there is a reason for a review in the respiratory clinic.” ( see also respiratory Vickis NZ Health Human Rights)
In respect of mammography “ On receiving your concern Dr Kim Shepherd requested Dr Walker ( Clinical Director for Breast Screening Waitemata-Northland) review the images and she agrees with Dr Shepherd’s email to you on 19 June 2017- I have looked at this mammogram with my colleague Dr Wild. The appearance you have shown on your first magnified image is normal skin and subcutaneous tissue. I would like to reassure you that I can see no areas of concern on your mammogram” . This still does not appear to be a satisfactory explanation.
My complaint was emailed to Andrew Simpson Chief Medical Officer of Health at the NZ Ministry of Health . A reply was received on 6 June 2018 :
“As Chief Medical Officer, it is not appropriate for Dr Simpson to comment or give clinical advice on individual cases. I note that you have been in contact with the Health and Disability Advocacy Service and the Health and Disability Commissioner which are the correct places for consumers to raise concerns they may have about the care or treatment they receive.
Kind regards
Clare Possenniskie | Principal Advisor to the Chief Medical Office
Ms Possenniskie does not seem to have read my Human rights complaint and seems to have ignored the unsatisfactory aspects associated with my previous complaint to Health and Disability.
Neither a reply nor an acknowledgment of the receipt of my email dated 25 June was received from the NZ Health practitioners Disciplinary Tribunal.
An email was also sent to the NDHB cancer and blood service on 13 September 2018. Staff member Toni Andrew replied : “Sorry we cannot accept this as a referral, you need to see your GP and get referred through the system to either the breast clinic or us (if confirmed cancer).”
An email was received from the office of the Minister of Health David Clark on 18 December 2018 in response to my two complaints including an abbreviated version.
“Kia ora Jordan Andrews Jordan.Andrews@parliament.govt.nz
On behalf of Hon Dr David Clark, Minister of Health, thank you for your correspondence. The Minister has noted your comments and has asked the Ministry of Health to respond to you directly about theissues you have raised. Please be aware, there may be a delay in responding to your correspondence due to the Christmas close down period.
Ngā mihi Jordan”
On 25 February 2019 he further advised “please be assured your correspondence is being treated seriously and you will receive a response. I sincerely apologise for the delay in responding to your correspondence.”
Correspondence from the Ministry of Health is detailed below:
MINISTRY OF HEALTH
March 2019 Ref DR 19915
“Dear Ms Wilson,
Thank you for your correspondence of 17 December 2018 and 25 February 2019 to the Minister of Health, Hon Dr David Clark, regarding your experiences. The Minister has referred your correspondence to me and asked that I respond to you directly. I understand that you have made a complaint to the Health and Disability Commissioner ( HDC) and the Ombudsman. The High court can also review the process used by the HDC to reach a decision. If you are not satisfied with the process used by the HDC or the Ombudsman to investigate your complaints, you may wish to seek independent legal advice on this course of action.
Community Law offers free legal advice throughout New Zealand. You can find he contact details for your nearest Community Law Centre on its website ( communitylaw.org.nz)
I am sorry this not the response you were hoping for . I wish you the very best.
Yours sincerely, Hina Davis Manager Ministeral Services”
On 8 May 2019 I emailed my complaint to the Medical Council of NZ and on 24 May received a reply from Anna Yardley Team Leader Professional Standards advising that “A member of the Professional Standards Team will be in touch with you shortly regarding your concerns”.
A reply was received from Megan Williams Professional Standards Adviser for the MCNZ on 10 July 2019. She advised “ Unlike the HDC the Medical Council of New Zealand does not have he ability to investigate care provided to an individual. The HDC may refer concers to the Council for consideration under our juridsdiction however, Council is only able to consider the case in the context of whether the matter indicates wider competence or conduct concerns about an individual doctor whch may require further action by Council”. Since the HDC investgates and publicises its decisions one wonders how many of their cases are actually referred to the MCNZ for further consideration and how much duplication there may be between the MCNZ and the Medical Disciplinary Committee. The MCNZ could have been an alternative backstop for those patients who are dissatisfied with the decisions of the HDC however unfortunately that is not the case.
In response to my email which also contained respiratory images I received a reply from Professor J Zalcberg Head of Cancer Research at Monash University on 13 July 2019. He advised:
“Thank you for your correspondence but I am unable to help.
I do not provide medical opinions over the internet and as respiratory medicine is not my area of expertise, it would not be appropriate for me to comment. I’m sorry I’m cannot assist
Regards
Professor John R Zalcberg OAM MB BS, PhD, FRACP, FRACMA, FAHMS, FAICD
Tony Charlton Chair of Oncology Alfred Health Head, Cancer Research Program”
On 28 January 2020 I emailed Dr Mcauliffe Director of Labtests: “On occasions, and in respect of laboratory sputum tests microscopy details can be identical i.e.” mixed organisms seen- predominantly gram negative bacillus” in different reports but only one report will specify a culture. In my case it is most often pseudomonas aeruginosa. An example of this are the two labtest reports dated 29/7/2019 and 7/12/2019. If no culture is reported then medication not provided by the general practitioner.The labtest report dated 14 October 2019 seemed to represent a departure from the norm ” mixed organisms seen- predominantly gram negative coccus including mixed gram negative organisms “. The coccus was not specified as a culture however that group can include meningitis ( previous MRI scan- undiagosed and untreated) and Haemophilus influenzae . I have been afflicted with both of those infections in the past. Aeruginosa might also have been present.” In addition I also provided images of 2 chest sputums dated 30 December 2019.
Dr Mcauliffe’s reply dated 28 January 2020 is detailed below:
“Labtests laboratory is accredited by IANZ ( Interntional Accreditation New Zealand). All our tests are carried out and reported according to established international guidelines. This includes sputum testing and resulting. Unfortunately we are unable to comment on your specific clinical questions. Such comments are only appropriately given by the medical practitioner who has the full clinical record of your symptoms and clinical examination. We are always happy to discuss individual results with referrers if there is query on interpretation of results or treatment schedules. We advise that you would be best seeking advice and care from your medical practitioner.
Yours sincerely,
Dr Gary MCauliffe
Clinical Microbiologist Labtests Auckland
Medical Director Labtests and Northland Pathology Laboratory”
During my previous consultation with Dr Cunningham on 17 December 2019 he seemed to be disinterested in the question of disparities concerning the lack of reporting of cultures and was not prepared to provide a prescription for antibiotics despite my symptoms of head chest and back pain.and a very sore throat. Dr Miller had adopted the same attitude with regard to the previous test dated 7 December. In the week after the consultation with Dr Cunningham I developed a severe chest and sinus infection which lasted for a week and resulted in copious amounts of dark yellow sputum from both the chest and sinuses.The test of 9 January 2020 reported “large numbers of polymorphs-culture: mixed gram negative organisms- no predominant organism seen?” One would have assumed that the sputum indicated yet another significant growth of Pseudomonas aeruginosa. I managed to reduce the severity of the symptoms with natural remedies.
I also cited the lack of treatment of my mother during the last week of her life in ADHB in November 2013.
ADHB hospital labplus report for P Sexton dated 27 October 2013 advised “Muco-purulent large numbers of gram positive cocci seen- large numbers of gram negative bacilli seen Culture: a moderate growth of mixed oropharyngeal flora///gram negative organisms (mixed species) ////at least three different organisms present” ( Al Anbuky) The lack of a significant culture seemed to be totally inadequate.
Patricia had previously been treated for staph aureus with flucloxacillin a few months earlier and one might assume that the gram negatiive organism was pseudomonas aeruginsoa most often associated with cancer patients in hospital. A month before she died in November 2013 she was diagnosed with lymphangitis carcinamatosis secondary to lung cancer. Despite the fact that mother was complaining of pain in her chest and back ( she also had a heart condition) and that her nursing notes indicated “productive cough with greenish sputum“ she was not provided with antibiotics . When I enquired of hospital staff I was advised there was no infection. Gerontologist Dr Spriggs considered ” that antibiotics were a waste of time as she was at the end of her life” and Dr Lim wrote on the day of her death. ” ‘I explained that she is unable to swallow in her recent condition and to put in an intravenous line would be cruel and inappropriate: sputum culture Nil infection,” She literally groaned her way to her death on her final day until she quietened down with with morphine.
MENTAL HEALTH/PSYCHOLOGICAL OPERATIONS
In October 1985 I had barely recovered from an undiagnosed illness only to be incarcerated in a mental hospital at the instigation of my own parents. My mother ( a former nurse) in particular seemed to have a rather obstructive attitude toward my evidence gathering either my attempting to record the electronic comments or the distorted diatribe emanating from a certain short wave station which broadcast all aspects of this case.
The reason for the obvious complicity of my parents has yet to be explained. The reason was my complaint about harassment from a local satanic cult. I was, as you would expect, classified as a delusional and paranoid schizophrenic. I retain copies of my mental health documents dated 1985 but the comments from my parents who initiated the committal seemed to be totally lacking from the reports. I emailed Mr J Hammond of Mental Health, Addictions & Intellectual Disability Service 3DHB on 15 November 2021 in this regard but received no reply.
Although my parents were the instigators neither my own General Practitioner ( Dr Delaney) nor my parent’s General Practitioner ( Dr Waite) were involved in my incarceration into a psychiatric institution in 1985. Instead a locum( Dr Brown) appeared at the house and subsequent to discussions I was coerced into visiting a psychiatrist ( Dr Delahunt) at Wellington public hospital. It was obvious that the psychiatrist in question was not interested in any explanations and I was committed to a public mental hospital. I was quite shocked. Regardless of the the committal order which quite plainly stated that I was “neither suicidal nor dangerous” I was treated like a common criminal and given a police escort with 3 police officers.
I was consigned initially to a secure ward, my personal possessions were taken away and put into a cell with only a mattress on the floor . I had nothing to eat or drink from 3pm of the previous afternoon until the day after my arrival at the hospital. I was confined to this ward for a few days wearing a chenille dressing gown and oversized men’s slippers. After approximately a week I was consigned to the open ward –surely an indicator that an incorrect assessment had been made in the first instance. The presiding psychiatrist was (Dr Averi.)
My parents then decided to send me to another privately run institution Ashburn Hall in Dunedin. Ironically the psychiatrist ( Dr Carradock Davies) at this establishment did not see fit to place me into the equivalent of the public hospital’s open ward and I was confined to the schizophrenic ward for virtually the duration of my stay there. Subsequent to my release and consultation with another psychiatrist in Auckland I discovered that my status was that of a “committed patient on trial leave”.
We were certainly not advised that this was my status prior to departure from the hospital in early 1986 however the matter was rectified by my subsequent psychiatrist (Dr Ogg of the Bexley Clinic in Auckland ). Interestingly his assessment was somewhat at variance with that of hospital psychiatrists stating that “ I presented in a completely normal fashion..it was clear that her effect was quite congruent with what she was saying ..her account was entirely coherent and compatible with her effect…found no evidence of any formal thought disorder”
Advice from a Mental health officer provided some rather contradictory advice, namely that while it was the usual practice to use the police force for the purposes of escorting patients from the Wellington Psychiatric Unit to Porirua in the 1980’s the officer in question was unable to locate any information concerning the reason for the use of a police escort in my case. In February 2009 The Clinical Director of Capital and Coast District Health Board Dr Masters advised thus :: “the file does not provide adequate detail to comment on your complaint regarding the initial treatment that you received on admission to hospital…from the perspective of today these practices can appear to be inappropriate at the least I can assure you that the use of a police escort would not result in a police record”
I had complained about the electronic projection of comments into the house on a twenty hour basis for the purpose of harassment and destabilisation. Voyeurism, which resulted in an immediate reduction in sound, negated any attempts to record the comments . Obviously the establishment of my sanity is a priority and to this end there is public evidence available . A certain short-wave station broadcasts a diatribe concerning all aspects of this case . With technical assistance extracts could be presented as evidence and the psychiatrist’s diagnosis reassessed accordingly. There are anomalies when it comes to matters of a spiritual nature-haunted house syndrome, programs devoted to the supernatural, even visions are classic examples. Most of these claims are heresay and unprovable . Rarely however, do these revelations result in incarceration for the individuals involved. I am surely nothing more than the victim of brilliant set-up/entrapment –“black psychiatry” In August 2017 media reported “ that mysterious incidents caused physical symptoms-hearing problems in at least 16 American linked to the American embassy in Cuba in what has been described as “ an acoustic attack”
An EEG report from Wellngton Hospital dated 22 October 1985 advised : “EEG obtained from a tense patient with constant flickering of eye movement shows a symmetrical alpha rhythm at 8-9 Hz of variably moderate amplitude attenuating on eye opening . Low amplitude ill-defined theta activity at 6-7 Hz is recorded pre-centrally. Hyperventilation well done and photicstimulation caused no significant changes. Comment: the EEG shows no significant abnormality.” However the Hospital apparently had no trace of my CT brain scan undertaken in the same year.
MEDSCAPE:
Normal EEG Waveforms
The frequencies most brain waves range from are 0.5-500 Hz. However, the following categories of frequencies are the most clinically relevant: Alpha waves – 8-13 Hz///Beta waves – Greater than 13 Hz///Theta waves – 3.5-7.5 Hz//Delta waves – 3 Hz or less
MENTAL HEALTH DAILY:“Alpha Waves
This frequency range bridges the gap between our conscious thinking and subconscious mind. In other words, alpha is the frequency range between beta and theta. It helps us calm down when necessary and promotes feelings of deep relaxation. If we become stressed, a phenomenon called “alpha blocking” may occur which involves excessive beta activity and very little alpha. Essentially the beta waves “block” out the production of alpha because we become too aroused. Frequency range: 8 Hz to 12 Hz (Moderate)
Too much: Daydreaming, inability to focus, too relaxed/Too little: Anxiety, high stress, insomnia, OCD//Optimal: Relaxation//Increase alpha waves: Alcohol, marijuana, relaxants, some antidepressants
“Theta Waves This particular frequency range is involved in daydreaming and sleep. Theta waves are connected to us experiencing and feeling deep and raw emotions. Too much theta activity may make people prone to bouts of depression and may make them “highly suggestible” based on the fact that they are in a deeply relaxed, semi-hypnotic state. Theta has its benefits of helping improve our intuition, creativity, and makes us feel more natural. It is also involved in restorative sleep. As long as theta isn’t produced in excess during our waking hours, it is a very helpful brain wave range.
Frequency range: 4 Hz to 8 Hz (Slow) Too much: ADHD, depression, hyperactivity, impulsivity, inattentiveness
Too little: Anxiety, poor emotional awareness, stress///Optimal: Creativity, emotional connection, intuition, relaxation//Increase theta waves: Depressants´”
Scottsdale Neurofeedback Institute: “Normal Occurrence of Theta Waves
Theta waves oscillate about 3.5 – 7.5 times per second (Hz). Some consider Theta to be from 4 – 8 Hz. Theta is normal in small very amounts in the healthy waking adult EEG. Theta in the adult waking EEG should be symmetrically distributed. Theta at the scalp surface in the adult EEG is normal as part of the early stages of drowsiness.
Excessive Theta activity in the waking raw EEG of adults is considered abnormal. It can represent reduced metabolism cortical grey matter (too little oxygen uptake). Theta that is asymmetrically distributed in the waking adult EEG is considered abnormal (more on one side than the other)
Spike and slow wave complexes that occur in seizure disorder often occur in the Theta frequency range.Excessive Theta on quantitative analysis is often seen in conditions such as… ADHD//Learning disabilities//Head injuries or brain lesions//Certain neurological disorders”
SCHIZOPHRENIA BULLETIN: To conclude, we found evidence that high-frequency activity in resting state EEGs may function as an endophenotype for schizophrenia. Schizophrenia patients and first-degree biological relatives of schizophrenia patients exhibited increased beta activity in their resting state EEGs during an eyes-open condition. Excessive EEG high frequencies in schizophrenia may relate to anomalies of the prefrontal cortex that are neural manifestations of genetic liability for the disorder. The present study also provides evidence for augmented low frequencies in resting state EEGs of schizophrenia patients as reflective of the disorder’s pathophysiology. Consistent with the presence of disorder-specific resting state functional brain abnormalities, schizophrenia patients exhibited increased activity in delta, theta, and alpha ranges, while similar anomalies were absent in bipolar disorder patients
Machine-learning-based diagnosis of schizophrenia using combined sensor-level and source-level EEG features :
“In this study, we used both sensor-level and source-level features extracted from EEG signals recorded during an auditory oddball task for the classification of patients with schizophrenia and healthy controls. EEG signals were recorded from 34 patients with schizophrenia and 34 healthy controls while each subject was asked to attend to oddball tones. Our results demonstrated higher classification accuracy when source-level features were used together with sensor-level features, compared to when only sensor-level features were used. In addition, the selected sensor-level features were mostly found in the frontal area, and the selected source-level features were mostly extracted from the temporal area, which coincide well with the well-known pathological region of cognitive processing in patients with schizophrenia. Our results suggest that our approach would be a promising tool for the computer-aided diagnosis of schizophrenia”.
Most patients classified as schizophrenic exhibit diminution in grey matter. In December 2007 a neurologist ( Dr B Snow) classified my MRI brain scan as normal or structurally non-schizophrenic. “ The cerebral hemispheres and ventricles were of normal size . There was no evidence for ventricular hypertrophy or temporal lobe atrophy which has been reported in schizophrenia. There were a few minor T2 hyperintensities in the cerebral white matter of no clinical significance” (Dr Snow) recommended that I should consult a psychiatrist as refuting of the diagnosis of schizophrenia solely on the basis of a normal MRI scan would not be likely.
Wikepedia advises “In addition, significant cortical grey matter volume reductions are observed in this disorder. Specifically, the right hemisphere atrophies more, while both sides show a marked decrease in frontal and posterior volume. disorder.
Most schizophrenics also have three times the normal amounts of dopamine receptor in their brains . “Schizophrenia has been shown to involve elevated levels of dopamine activity in the mesolimbic pathway and decreased levels of dopamine in the prefrontal cortex’[5].Dopamine is part of the catecholamine group also known as metanephrines.” A urine metanephrine test dated 21 January 2013 was essentially normal @ 260 nmol/d ( 0-1150 ). I can confirm that the urine collection was collected over a 24 hour period despite a qualification from the laboratory that “The low creatinine output suggests this may be an incomplete 24 hour urine collection unless this patient has a very low muscle mass.”
Attempts to obtain the results of psychological tests and brain scans from 1985 have to date proved unsuccessful. The former Director of the psychiatric institution Ashburn Hall ( Dr Du Fresne) was unable to locate my psychological test in 2007. The psychological tests were referred to in a psychiatric report from Dr Carradock Davies to Dr Basil James in which Davies advises “Cognitively she is functioning well and is of superior intelligence according to our psychological testing”. The tests were provided by a former American staff member psychologist/ psychotherapist Dr Bernhardt of Kansas/Chicago. As I recall they not indicate any significant abnormality either. Since March 2013 my emailed requests for the psychological report have met with singularly unhelpful replies . On 28 May 2013 the Administration Manager of Ashburn Hall Kate Ryan advised “ we also advised you by letter in 2007 that we were not holding the Psychological tests/report that you refer to . I am sorry we cannot assist further with this”
I then lodged a complaint with the Privacy Commissioner –the reply is thus:
Dear Vicki Wilson,
Your email was forwarded to the Complaints team and it was determined that as your requests were made in 2007/08 – and you were told the report doesn’t exist, the Office of the Privacy Commissioner would not be able to address especially as that issue as it was too long ago.
In regard to the use of psychological testing apparatus: that would not raising a privacy issue, in terms of the Privacy Act, the Privacy Act did not exist in 1985.
Regards Fred Henderson
Psychiatrist Dr Carradock Davies clearly indicated that psychological testing had occurred . Irrespective of the fact that the agency is unable to assist because of the time limit Principle 5 of the legislation states “ that an agency that holds personal information shall ensure that the information is protected …..against loss ……” It is a matter of concern surely that either medical or psychiatric records can go astray without further investigation.
The Mental Health Act (1992) advises:
75 Complaint of breach of rights
(1)Where a complaint is made by or on behalf of a patient that any right conferred on the patient by this Part has been denied or breached in some way, the matter shall be referred to a district inspector or an official visitor for investigation.
(2) If, after talking with the patient, the complainant (where that is not the patient), and everyone else involved in the case, and generally investigating the matter, the district inspector or official visitor is satisfied that the complaint has substance, the district inspector or official visitor shall report the matter to the Director of Area Mental Health Services, together with such recommendations as the district inspector or official visitor thinks fit, and the Director of Area Mental Health Services shall take all such steps as may be necessary to rectify the matter.
(3) On concluding any investigation under this section, the district inspector or official visitor shall also inform the patient or other complainant of his or her findings.
(4) If the patient or other complainant is not satisfied with the outcome of the complaint to the district inspector or the official visitor, he or she may refer the case to the Review Tribunal for further investigation; and, in any such case, the provisions of subsection (2), with any necessary modifications, shall apply.
My attempts to obtain assistance from two district inspectors of mental health proved unsuccessful with in my opinion further evidence of blatant disregard by the legal profession. I can see no time limit imposed in the legislation particularly section 75 that precludes an investigation prior to that time.
In his email dated 18 September 2013 District Inspector Andrew Molloy advised:
Dear Vicki
The legislation under which you were treated was the Mental Health Act 1969. That Act was repealed upon the coming into force of the 1992 Act. My appointment is as a District Inspector under the 1992 Act. Section 75 of that Act covers complaints that have arisen since the 1992 Act came into force. It does not cover anything that happened to you, or to anyone, under the 1969 Act. However, it may not surprise you to learn that there are many people who have a sense of grievance arising out of the manner of their treatment under the 1969 Act. As a result of this the government has established what is called the Confidential Listening Service, which is under the leadership of a District Court Judge, Judge Henwood. It may be that this can provide you with the best means of making sense of what happened to you, and provide you with a clear sense of what you can do about it.
The service has a freephone , 0800 356 567.
If you wish to telephone me to discuss any of this please feel free to do so.
Andrew Molloy District Inspector for Mental Health
In her email dated April 2014 senior Queens Counsel and senior advisory district inspector of mental health Helen Cull stated:
“I note your complaint with regard to your incarceration in Porirua Hospital and Ashburn Hall, Dunedin in October 1985 to January 1986. In n my role as Senior Advisory District Inspector, I am not permitted to provide opinions to former patients under the Mental Health Act. If however you wish to seek legal advice, may I suggest you contact the Community Law Office, which will recommend lawyers practising in the area of Human Rights Law.” Apparently Ms Cull was not au fait with her role in relation to patient complaints.
I attempted to enlist the assistance of yet another QC/ District Inspector of mental health namely Ms J Young of Whangarei in December 2014. In her email dated 12 January 2015 Ms Young advised “As you are probably aware I am a lawyer and not a doctor so would be unable to answer the medical questions that you pose. I can help with jurisdiction and also complaints under the Mental Health act as they pertain to a patient in the legal sense of matters.”
In her email dated 27 February 2015 Ms Young further advised “I have had the time to consider the complaint you forwarded. It seems that you have brought this to the attention of a number of other professionals including Helen Cull the senior District Inspector and Andrew Malloy a district Inspector in Auckland. I am unable to assist with this request as I believe that it requires consideration from a medical point of view as the basic contention is that you were not unwell at times that you have been treated by clinicians in the past. I hope that you do find the assistance you require”.
Ms Young’s comment “as the basic contention is that you were not unwell at times that you have been treated by clinicians in the past” can only be regarded as nonsense.
In my email to Ms Young dated 19 January 2015 I expressed my concern that “ The repercussions of this erroneous incarceration have been significant and include apartheid, and in respect of the medical profession , scant regard, even falsification. It is a blatant experimental case of psychological operations which incorporates unusual technology for the purposes of voyeurism and harassment, incorporating elements of ritual abuse, and the use of the mentally impaired for bio hazardous exposures.
Obviously I would appreciate your assistance in having that original diagnosis of schizophrenia revoked by psychiatry. One might also need to take into account the interrelationship between the instigators – the security services, medical, psychiatric and legal professions and the involvement of relatives amongst others”
The Mayo Clinic advises that in respect of schizophrenia “ a person must have at least two of the common symptoms of the disorder — delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, or presence of negative symptoms for a significant amount of time during one month
Experience significant impairment in the ability to work, attend school or perform normal daily tasks
Have had symptoms for at least six months”
On 10 July 2020 Criminal lawyer Rosemary Thomson advised “Thank you for your email. Your complaints do not come within my role as District Inspector for Mental Health. Rosemary L. Thomson District Inspector for Mental Health . A complaint to District Inspector for mental Prudence Free dated 11 July 2022 was ignored.
If one accepts the veracity of the use of ultrasonics and masers ( synthetic telepathy)in psychological operations as specified in this and other websites then this aspect should exclude the diagnosis of delusional and paranoid schizophrenia. Since schizophrenic patients must normally exhibit a minimum of two symptoms of the disorder and since none of the other criteria such as disorganized speech, catatonic behaviour,or significant negative symptoms are applicable in my case it might be inferred that I am now,and have always been mentally normal and the victim of a wrongful incarceration in 1985.
Despite many bouts of physical ill health I am a generally well organised and coherent person who has been largely responsible for the administration maintenance and décor of the family home including the welfare of an elderly and failing parent.
Of interest is “Schizophrenia: Reliability and Validity of diagnosis” Professor Rosenhan ((deceased) was a professor of psychology and law at Stanford University conducted a an extract from a study entitiled ‘Sane in Insane places” study “To illustrate how clinicians can wrongly diagnose schizophrenia. Rosenhan conducted the this study with 8 volunteers (including Rosenhan himself and 5 doctors/psychologists) arrived at several hospitals reporting only one symptom, that they could hear voices saying ‘hollow’ and ‘thud.’ All 8 were admitted into the hospitals that they arrived at and while they were there they acted as model patients in a bid to be released as soon as possible. The results showed that the average length of stay was 19 days with the longest person staying 52 days. Every single volunteer was diagnosed as suffering from schizophrenia in remission even though there was absolutely nothing wrong with them. This shows that validity of diagnosis was poor as the volunteers has been wrongly diagnosed” Acccording to website Helpguide.org a common delusion is the “ Delusion of control – Belief that one’s thoughts or actions are being controlled by outside, alien forces. Common delusions of control include thought broadcasting (“My private thoughts are being transmitted to others”), thought insertion (“Someone is planting thoughts in my head”), and thought withdrawal (“The CIA is robbing me of my thoughts”).
However evidence concerning mind control activity much of which I have experienced personally and which is downloaded from different sources is detailed below:
Lone star consulting( lonestarconsultinginc.com/mindcontrol.htm) advise “ hearing voices or sounds in your head or your thoughts being repeated back to you that are not caused by a medical condition and appear to be emanating from external sources that you can’ t seem to pinpoint? You may have tried to record these sounds but with no luck. This is because the most modern and popular audio digital recorders and tape recorders are not designed to record faint sounds sound bursts ultrasounds and infrasounds. Lone star consulting provide a SSSD specially designed interface unit that plugs into the mike input of a digital recorder –it uses automatic gain control (AGC) which is invaluable because it results in maximum amplification of faint sounds but automatically adjusts for less amplification for louder sounds . Ultrasonic signals by themselves, carriers, infrasonic modulating ultrasonic carriers and audio signals modulating ultrasonic carriers are highly characteristic of electronic attack and mind control technologies”`
At Walter Reed Army Hospital of Research in 1973 Dr Joseph Sharp strapped inside an isolation chamber heard “ words” beamed at him in a pulsed microwave audiogram. An audiogram is a computerizied analog of the spoken voice ARPA’S Robert O Beck foresaw in the experiment obvious applications in covert operations. Becker imagined a barrage of voices driving an enemy insane .
A psychoanalyst Carole Smith (soleilmavis spaces live.com/Blog) expressed some concern over the American Psychiatry Association’s Diagnostic Criteria for Schizotypal personality. “The third Edition ( 1987) of Diagnostic and Statistical Manual of Mental disorders ( DSM) required that there be at least four of the characteristics set out for a diagnosis of schizophrenia and an approved selection of four could be: magical thinking, Telepathy or sixth sense limited social contact, odd speech and over sensitivity to criticism. By 1994 the required number of qualifiying characteristics were reduced to 2 or more. Including hallucinations and “negative” symptoms such as affective flattening , or disorganised or incoherent speech- or only one if the symptoms were bizarre or the hallucination consisted of a voice keeping up a running commentary on the persons behaviour or thoughts. But if the accounting of bizarre experiences more or less guaranteed you a new label or a trip to the psychiatric ward there is even more reason for a new group of people to be outraged about how their symptoms are being diagnosed. A doubly cruel sentence is being imposed on people who are the victims of the most appalling abuse by scientific-military experiments and a totally uncomprehending society is indifferent to their evidence. For the development of a new class of weapons now has the capability of entering the brain and mind and body of another person by technological means.
Satellite technology is used not only for surveillance and communication systems but also to lock on to human beings manipulating brain frequencies by directing laser beams, neural partical beams, electro magnetic radiation sonar waves radiofrequency radiation soliton waves torsion field . In particular pulsed radio frequency radiation is used for manipulating and disturbing the human mental process and for causing negative effects on human health and thinking. The beam is administered from space. The development over the last decades since the Cold War arms race has included as a major strategic category psycho-electronic weaponry the ultimate aim of which is to enter the grain and mind. The only witnesses to this terrible technology are the victims themselves and those who are given the task of diagnosing mental illness are attempting to silence them by classifying their evidence and accounts as the symptoms of schizophrenia, while the dispensers of psychic mutilation and programmed pain continue with their work unopposed.
It was always crucial under the threat of psychiatric sectioning to carefully screen out any sign of confused speech negativity coldness suspicion bizarre thoughts sixth sense telepathy premonitions but above all the sense that “ others can feel my feelings and that someone seemed to be keeping up a running commentary on your thoughts and behaviour” then reporting these to a psychiatrist or anyone else for that matter who was not of a mind to believe that such things as mind control could exist, would be the end of your claim to sanity and probably your freedom. For one of the salient characteristics of mind control is the running commentary which replicates so exactly and surely not without design the symptoms of schizophrenia Part of the effort is to remind the victim that they are constantly under control or surveillance. Programmes vary but common forms of reminders are electronic prods and nudges body noises twinges and cramps to all parts of he body increasing heart beats applying pressures to internal organs all with a personally codified system of comments on thoughts and events designed to create stress panic and desperation. This is mind control at its most benign.
There is reason to fear the use of beamed energy to deliver lethal assaults on humans including cardiac arrest and bleeding in the brain. In 2001 congressman Dennis Kucinich introduced a bill to the House of Representatives which it was hoped would be extremely important in the fight to expose and stop psycho-electronic mind control experimentation on involuntary non-consensual citizens . The Bill was referred to the committee on Science and in addition to the committee on Armed Services and International Relations. There was however no mention in the revised bill of any of the aforementioned mind-invasive weaponry nor any other technology designed for deployment against the minds of human beings.
In England on May 25 1995 the Guardian newspaper in the UK carried an article based on a report by Nic Lewer, the peace researcher from Bradford University, which listed “ more than 30 different lines of research into new age weapons. There are according to Lewer plans for pulsed microwave beams to destroy enemy electronics and separate plans for very low frequency sound beams to induce vomiting, bowel spasm, epileptic seizures and also crumble masonry. There are also plans for mind control with the use of psycho –correction messages transmitted by subliminal audio and visual stimuli. There is also a plan for pychotronic weapons apparently the projection for consciousness to other locations.
Black psychological and psychiatric operations involves using the mentally and psychically impaired///the use of bio weapon///24 hour harassment///tormenting and goading victims///playing back bodily functions against the victim///criminalising the victim ///the monitoring sub-vocalised thought patterns.
Another article entitled ” Mind control and ritual abuse” describes methods as follows:
Dysfunction: methods causes memory loss blocking of awareness ( disassociation) and mindless obedience
Densitisation: Diminished thoughts emotions and behaviors are replaced with induced responses.Individuals are manipulated isolated and debilitated. Physical biological and psychogical attacks weaken individuals. Tactics and drugs employed destroy self-sufficiency and force reliance on manipulators. Cruelty and confusion techniques create depression uncertainty numbness fear and rage. Controllers manage the people and situations . Imposed behaviors are reinforced and events covered up.
In Essays on Mind Control by Allen Barker (Mental Firewalls) ( jbhfile.com/Part III Mental Firewalls .htm) advises “ there truly are some people with mental illnesses which occur naturally. There are also people with mental illness which were externally and purposely inflicted for example by harassment operations It is common knowledge that the mentally ill have used as guinea pigs in mind control experiments precisely because they would tend to be disbelieved and are relatively powerlesss victims for torturers to experiment on. Abuse includes psychosurgery, microwave harassment etc.which can cause organic problems in addition to psychological problems. The victim is under constant surveillance.The victim is harassed overtly and covertly . All forms of taunting and goading tend to occur. The victim soon has to wonder about everything that breaks or goes wrong in their lives. The victim is purposely isolated . People close to them are threatened or deceptions are created to make the victim suspect those closest to him or her. Unfortunately in the despicable circles of mind control it is sometimes the neighbour or even a close family member that is truly responsible.
The victims mind is under assault with voice projection voice cloning The Village Voice in an article from July 2001 titled “psycho warfare” described an Air Force report uncovered by Nick Begich. Quoting from the article “ twenty four hours a day the victim is subjected to commands ridicule and distractions inside his or her private mind. Finally the victim’s supposedly private subvocalized thoughts are somehow read or inferred and analysed . There are various levels at which this can occur from remote heartbeat up to and including brain implants telemetering EEG signals. Sex, defecation, burping etc and normal human emotions such as worrying and anxiety are turned against their victims. The perpetrators constantly attempt to demean their victims and turn all of these human properties against their victims.” Ultrasonics views homeless people as a definite threat to neighbourhood communities and are actively running homeless people out of the community with sonic weapons . Improper use of the mentally impaired can include the use of bio weapons///24 hour harassment//tormenting and goading the victim///playing back bodily functions///criminalising the victim and monitoring sub-vocalised thought patterns
Law enforcement can easily brush off the complaints by the targeted homeless because the general public assume that most homeless people are mentally ill. In my opinion there is a massive organized effort being mounted against mentally ill people in this country to drive them out of neighbourhood communities and force them into mental institutions and onto prescribed medications. Ultrasonics attack you relentlessly and will attempt to get you to turn violent thus precipitating forcible placement in a mental institution.
The American Psychiatric Association does not recognize the possibility that high technology may be used to create or mimic symptoms of mental illness in a person. Therefore a psychiatrist does not have to consider the possibility of high technology when diagnosing mental illness. There is a safety net for psychiatrists doctors lawyers and law enforcement if somehow the use of this technology becomes public. This is plausible deniability or simply denying any knowledge of what they did thus enabling them to continue to damage and destroy people’s lives indefinitely and not be accountable for anything.
Another article entitled “ What is mind control?” advises that when serious lies are used to cause carefully scripted harassment and electronics used to destroy faculties the target’s life is virtually worthless. The symptoms of mind control can include:
Excruciating pain///// blanking of recent memories////sudden enforced wakening at precisely the same time in the middle of the night//// the “injection of air from nowhere” inside the upper lip when the lips are firmly closed, and the tongue and cheeks are blocking air from the lungs – this injection is used to keep the target awake as it results in a loud noise like flatulence////sudden clumsiness////attacks of extreme fatigue////wildly racing heart without any cause//// artificial and powerful sexual stimulation///, around the clock transmissions usually insulting and/ or threatening to indicate that you are under surveillance. The external symptoms can include: many wrong number calls///theft of personal papers and records particularly those which the target doesn’t access often////tradesmen botching the job or overcharging///chronically erratically performing computers//spreading rumours that the victim has a criminal record////non-stop attempts to crush religious faith//
A quote from Dr José Delgado, Director of Neuropsychiatry, Yale University Medical School Congressional Record, No. 26, Vol. 118 February 24, 1974 states: “We need a program of psychosurgery for political control of our society. The purpose is physical control of the mind. Everyone who deviates from the given norm can be surgically mutilated.” “The individual may think that the most important reality is his own existence, but this is only his personal point of view. This lacks historical perspective. Man does not have the right to develop his own mind. This kind of liberal orientation has great appeal. We must electronically control the brain. Someday armies and generals will be controlled by electric stimulation of the brain.”
A specific reference to the involvement of the intelligence community personnel in mind control is contained in an article entitled “ Microwave Mind Control” by Tim Rifat (whale.to/b/rifat/html.) “Transducers are used to modify the spoken word into ELF audiograms that are then superimposed on the pulse modulated microwave beam. There are also the laser equivalent of microwave beams. These MASER beams have been used to develop something called synthetic telepathy. This is the ability to read people’s minds from a distance Electronic scanning of victim’s brains by monitoring the electromagnetic (EM) emissions from people’s brains and using among other things the brain waves ( as measured on a EEG) to read the victims subvocalised thoughts.
Secondly, the police have been granted the exclusive use of the 450 MHz microwave frequency range. This is exactly the frequency used by Dr Ross Adey, the CIA mind control expert, in his experiments on behavioural modification. It seems the police have the exclusive use of this mind control frequency and a vast array of antennae to broadcast this frequency all over the country. Very useful for mass mind control in times of emergency. Adey found that by using 0.75mW/cm2 intensity of pulse modulated microwave at a frequency of 450 MHz, it was discovered that an ELF modulation could be used to control all aspects of human behaviour. The Sussex police headquarters is connected to CCTV, closed circuit television cameras throughout the town. Some of these cameras have microwave telemetry devices that could easily be used to broadcast this frequency. The large antennae that bracket the town could also be used.
The most insidious aspect of this, is that the entire mobile phone network could easily be used to control the behaviour of the phone users. By use of my microwave detector, I have found that mobile phones of the newer type, give off a pulse modulated microwave signal of around 0.75mW/cm2 at the earpiece. This may be coincidence, but it is exactly the intensity required for behavioural control as found by Dr Ross Adey, the pioneer of microwave mind control. So in theory, an ELF signal could be added to the microwave network to feed a precise behavioural pattern into every mobile phone user in the UK.
If there were widespread riots, the ability to broadcast behavioural stimuli to mollify all the mobile phone users in the country would prove useful. Since mobile phone users are generally middle class, it means authority has a useful method of controlling the behaviour of the key voters. Microwave carrier beams are perfect for transmitting the excitation potential of docility to the phone user to keep them servile in times of trouble. When no ELF signal is broadcast the phone acts in a completely different manner on behaviour in humans. In this case the microwave phones causes the neurones to release calcium ions which makes the user tired irritable and when stresses likely to emotional outbursts such as road rage.
In Brighton, the local MI5 headquarters has a large microwave array on its roof. Secret bunkers in the area also have large microwave arrays above them. It is child’s play to transmit an ELF modulated signal to be broadcast by the entire mobile phone network – if need be. By this means the entire mobile phone users can be behaviourally modified. At the cost of developing cancer from low level microwave exposure from the phones they constantly use, stressing the neural network by constant calcium ion efflux and interference with bioelectric fields.
It seems strange that a few milliCuries of ionising radiation will get the National Radiological Protection Board excited, whilst high intensity cancer inducing non ionising microwave radiation, goes unchecked. So high are levels near transmitters, that litter the countryside, that light bulbs will explode near them. If the intelligence community is using microwaves on a large scale as mass mind control weapons, then the NRPB’s silence is easily explainable. To add to this, the numerous microwave detectors that were cheaply available to check leakage from microwave ovens are no longer made by any company in the country. It seems the UK authorities do not want the population to be able to detect when they are being microwaved.
In conclusion, it can be seen that the UK intelligence and police, have a dizzy array of high-tech mind control devices. They regularly target their own populations and thousands of people are made ill by microwave weapons. With the advent of synthetic telepathy, ‘CCTV of the mind’ becomes a reality. External reinforcement by the intelligence community includes destruction of the target’s property ruining their financial affairs and vicious rumour mongering. “
NAZISM
It’s a rare occasion in a democracy when legal recourse is denied . This is surely nothing more than odious conspiracy and a gross abuse of power imbued with more than a touch of Nazism. . The association/marriage?) of an elderly female relative Miss Marianne Kassler (now resident in Epsom Auckland) with a former French nazi war criminal Mr Jacques Correze might be of relevance. Miss Kassler’s initial harassment involving derogatory comments concerning my intelligence and mental health continues occasionally to this day. She returned to Auckland in 1997 previously having lived in London since the mid 1950s where she may have been jailed for her involvement in a burglary ring and apparently left behind the names of 12 dead women. She had been renting an apartment from an American friend resident in San Franciso prior to her return to NZ. A summary of the background of Mr Correze is provided in Wikepedia and is also detailed in the book written Michael Bar-Zohar is as follows:
Bitter Scent The Case of L’Oreal, Nazis, and the Arab Boycott by Michael Bar-Zohar:
“A powerful expose that unmasks a giant cosmetic firm’s long history as a haven for French Nazis—sanctioned at the highest levels of the French government.
This is the true story of scandal and skullduggery in high places that rivals the intrigue of any fiction thriller. Set in the contemporary world of the glamorous cosmetics industry, its roots are in the Nazi occupation of France during World War II, and it involves leading political figures and business executives who are accused of protecting high-ranking French Nazis for the last five decades. It also involves a genuine hero, Jean Frydman—a man who as a teenager fought the Nazis in the French underground, and who as a contemporary media wizard and multimillioniare has made it his crusade to expose the French collaborators who have provided a haven and fortress for war criminals.
World famous as the symbol of beauty and glamour, L’Oreal became the target of an Arab boycott when it swallowed another cosmetic giant, Helena Rubinstein, whose founder had been a prominent Zionist. When Frydman was forced off the L’Oreal board with a letter of resignation apparently forged to satisfy the Arabs, he found himself confronted with the anti-Semitism he had fought against all his life. Determined not to let his L’Oreal partners get away with it, he learned that the forgery was made on the orders of one Jacques Correze, chairman of L’Oreal’s marketing group in New York and a former Nazi collaborator who had been convicted of war crimes after the Liberation. Frydman then filed suit against L’Oreal for financial malfeasance, fraud, forgery, racial and national discrimination.
It was one lone individual up against the powerful L’Oreal and the French establishment. But despite L’Oreal’s indignant denial of the charges, papers were found that revealed the whole dark story of negotiation between the cosmetics firm and the Arab Boycott Bureau. And as Frydman continued to dig into the records of L’Oreal’s past, he discovered more Nazi collaborators on their payrolls and a chain of connections that reached the highest level of the French government-President Francois Mitterand.
With the complete cooperation of Jean Frydman himself and rare access to other people involved in the scandals as well as to the legal documents, Michael Bar-Zohar has written an exciting, suspenseful book that proves once again how much stranger truth is than fiction.
LOreal has an unwholesome past regarding Nazi collaboration. Jacques Correze a convicted Nazi Collaborator, was hired by L’Oreal in 1950 after his release from prison and was assigned to the United States in 1954 and appointed Chairman of Cosmair in the late 1960s. He died in 1991. shortly after his past as the No. 2 man in the Nazi & French terrorist squad The Cagoule was exposed. Correze was also alleged to have belonged to several pro- Nazi groups during the war, including the Mouvement Social Revolutionnaire (MSR). But L’Oreal’s Nazi ties go deeper still: the companys founder, Eugene Schueller, is reported to have helped finance the MSR and later joined the pro-Nazi Rassemblement National Populaire.”
http://www.farinc.org/newsletter/v8_n3_-4_94/gleanings.html
My former rental home in whangarei is owned by the Japanese Watanabe family who are apparently resident in Auckland. Wikipedia advises that “ “Mutsuhiro Watanabe (Japanese: January 1, 1918 – April 1, 2003) was an Imperial Japanese Army sergeant in World War II who served at POW camps in Omori, Naoetsu (present day Jōetsu, Niigata), and Mitsushima (present day Hiraoka). After Japan’s defeat the US occupation authorities classified Watanabe as a war criminal for his mistreatment of prisoners of war (POWs), but he managed to evade arrest and was never tried in court .
HEALTH MATTERS
During 2007/2008 I lodged complaints with the Advocacy Service of the Office of Health and Disability Commissioner. Obstructive tactics seemed to be in evidence.
On 25 June 2008 I emailed a complaint to Ms Strid of Health and disability about the unnecessary and sometimes disjointed and incoherent attempts at editing my complaints by HDC advocate Aaron Morten.
In his letter dated 25 June 2008 Aaron advises “ Firstly, you make numerous reference to concerns about reports but you do not reference the authors and the relevance of including these and in future identify first your actual concerns and then reference the reports /consultations/research relevant to each of the concerns that you feel I have not been responded to. Furthermore a more structure approached that easily understood in terms what it is you are trying to address that is structure and straight- forward i.e. the background of the concern identify the issue what it is you want resolved and what do you believe is the best approach is the provider able to respond”
Dr Henrys: In respect of Dr Henrys, who despite Medlab’s diagnosis of a gram negative bacterial infection and a recommendation for drug treatment was initially reluctant to prescribe. This might also be considered to be significant as there has been a similar pattern/response from other general practitioners. Aaron’s response was“this is irrelevant” In the same letter I referred to the non-diagnosis of a broken toe by radiology and the non-reporting of some other incidental findings . Aarons response was “ Umm is there really a complaint who diagnosed the boken toe”. Regardless of the non-diagnosis, presumably I would not have been referred to radiology if a broken toe had not been suspected-I also experienced prolonged pain.
Dr Whyte: With regard to my letter to Respiratory Physican Dr Whyte I stated “ that pain and tiredness ( possibly indicative of a mild form of meningitis )are a common feature”. Aaron queried ( was Dr Whyte aware of the meningitis). In fact there was no specific diagnosis of meningitis, just my own suggestion,particularly as meningitis can be associated with gram negative infections. I quoted 2 paragraphs from Dr Whyte’s report. The paragraph concluded “ if the evidence points to the chest infection then she should consider admission for assessment and IV antibiotic therapy”. Aaron stated “ who advised you of this ,reference from another practitioner ? Report? E Journal?. I was quite obviously quoting from the report of Dr Whyte.
The Complaints Co-Ordinator ////Dr Pardy In respect of my complaint to the Auckland District Health Board there seemed to be confusion as Aaron changed/ juxtaposed the addressee namely the Health complaints Co-ordinator Auckland District Health Board cc. Gynaecological Clinic Greenlane Clinical Centre with a letter to Dr Respiratory Physican Dr Pardy. Aaron had ( correctly?) amended the addressee from Health complaints co-ordinator to Quality and Safety Unit. His notation was thus: “( was this referral to the DHB therefore the above contact details would suffice or did you attend an appointment at the Auckland Medical Specialists Respiratory Services who are in Newmarket”. My consultation with Respiratory Physician Dr Pardy at the Greenlane Clinical Centre occurred in March 2002. My written complaint to Julie Byers Complaints Co-Ordinator at the Auckland District Health Board concerning a gynaecological scan was dated 23 May 2005. I had also referred to Greenlane Radiology reports dated 30 November 1999 and 29 June 2002. In respect of the latter report Mr Morten stated ( was this report a result of the March 2002 performed Dr Pardy or someone else)
Dr Hartley :In my complaint concerning Dr Hartley I advised that when I tried to discuss a change in the symptoms in the late1980s. Dr Hartley curtailed the consultation. Hartley clearly specified in his report that “ when she was unwilling to listen to an alternative explanation as to what was going on I terminated the consultation” Aaron stated ( is this what Dr Hartley said, seems inconsistent and similar to a previous response to another General Practitioner complaint”) Inconsistency isn’t really the issue- if anything the consultation might be regarded as somewhat consistent and certainly similar to a consultation with General Practitioner Dr Tom Marshall who also aborted his consultation.
Dr Coral Fonseca: With regards to Dr Coral Fonseca I was concerned about her prescribing of allergy medication rather than antibiotics . Aarons response was : “ to resolve this complaint would to request whether these records were made available at the time during that consultation and whether there was any record of these. Concerns of access to these and if they were available at the time might be more relevant questions and since this Doctor is no longer at this clinic , and these questions would need to be posed to the Clinic itself, about whether they were present at that time”. I think this is a case of overstating the obvious- even though Dr Fonseca is now practicing at Great North Road Avondale medical records should be available concerning the date of the consultation date of 5 November 2005 at East Tamaki Health Care 5 Mayfair Place Glen Innes. Access to those records should not be a problem for Dr Fonseca.
Dr Kolbe : In contradiction the Medlab allergy tests which indicated allergies to rye grass silver birches and peanuts Dr Kolbe stated that I had no known allergies. Mr Morten stated ( do you want these detail amended if so request as a further desired outcome in the final paragraph). My final paragraph had specifically asked for an explanation as to this incorrect biographical detail. In respect of Kenneth Todar an American bacteriologist whose assessment contradicted that of Kolbe Morten asked ( who is Kenneth Todar why has he been included only in the last paragraph)
Dr Garrett : I quoted from Garrett’ report including a reference to his spirometry testing” a study of peak flow and expiratory scans……although she did have 61/2 ribs exposed anteriorly” FEV1 and peak flow measurement were considered to be within the normal range. Mr Morten’ statement ( are these the actual comments made by Dr Garrett –are your able to explain this furthermore did he have copies of these reports). Anyone with a rudimentary medical knowledge would be aware that spirometry testing is generally carried out by the specialist himself. It seems rather nonsensical to enquire whether the specialist had copies of the reports. In respect of the photos from bronchoscopy Morten enquired ( what photos yours, medlines Are they part of the report?) I had quite clearly stated that the photos were from the bronchoscopic procedure. Lavage results indicated a difference in the neutrophil cell levels between the left and right lungs. Morten stated ( Is this what Dr Garret stated or a reference to Mediline) Lavage results are obviously provided by Diagnostic Medlab. I had stated that on occasions “crackles” and “ rales” which are often associated with a diagnosis of pleurisy had been detected by general practitioners. Mr Morten commented (who said this reference to who? –from my understanding rales ( ostensibly crackles is a symptom-am querying the rationale for include the above two paragraphs and paragraphs with reference to Dr Todar). Todar had stated “that gram negative bacteria Pseudomonas Aeruginosa almost exclusively afflicts patients who are compromised in their lower respiratory tract or defence mechanisms and almost never infects uncompromised tissues” Despite subsequent detection of “ rales” by practitioners there has never been a repeat pleurisy diagnosis. While of interest the pleurisy diagnosis is not specifically relevant to Todar’s comments.
Dr Simcock: I had quite clearly specified that an Auckland Radiology report of a CT scan of the sinuses stated “ that the nasal septum is deviated slightly to the right…..which might predispose to oesteal obstruction …………” Mr Morten stated ( was this what the Radiologist report or Mr Simcock?) I also clearly quoted from Internet site E Med. Mr Morten stated ( you need to lead in from here with reference to the following i.e. from own independent research”) The comment “ from own independent research” might be considered extraneous and unnecessary –a case of overstating the obvious. Dr Simcock’s exclusion of the nose and sinuses as the source of my symptoms is contained in my letter of complaint. Mr Morten neverthless enquired ( Had he diagnosed bacteria?) Any bacterial diagnoses are provided by Diagnostic Medlab. Mr Morten’s comments once again indicates of comprehension. Mr Morten further states ( (ostensibly you are seeking his professional opinion about the diagnosis and further information about the condition and reports” I was obviously not seeking his professional opinion about the diagnosis. I obviously am concerned that a despite a 30+ year history of serious chest and sinus infections and on one occasion a laboratory diagnosis of gram negative cocci in sinus sputum coupled with occasions of frequent discharge from the nostrils Dr Simcock dismissed the sinuses as the source of my symptoms.
Dr B Snow: In respect of a C-Reactive Protein test Mr Morten enquired ( was this also included in Dr Snow’s report or is this an additional comment made by you?) This reference is an additional comment and was not referred to in Dr Snow’s report. I certainly discussed the thermography reports of 2003 which indicated a generalized inflammation and also the diagnosis of Myalgic Encephelomyelitis (ME). However neither of these 2 conditions were alluded to in Dr Snow’s report. His only reference to my history of gram negative bacterial and chest and sinus infections was a reference to” intermittent chest and sinus infections” Dr Snow reported “no carotid bruits” . Morten stated ( reference to the carotid is bruit is this relevant to the above topic or is this separate?) A carotid bruit is an abnormal sound heard with a stethoscope when checking the carotid artery in the neck. The artery carries blood to the head. It can indicate atherosclerosis. Checking for carotid bruits might therefore obviously also be considered relevant .
Dr Ng: I referred to the removal of a fibroadenoma from the breast measuring approximately 1 cmm. Although it is obvious in the script Mr Morten queried ( 1 cmm or mm). At the end of the last paragraph in which I stated “ I would appreciate your advice as to why excisional biopsy of the existing fibroadenomas/cyst aspiration had not been recommended “ Mr Morten stated (did you have an appointment with Dr Ng if so when –to remind you I can only assist if this is a complaint about the quality of treatment received by a practitioner but you do not specifically outline an appointment with Dr Ng at any time” Although I didn’t specifically refer to the consultations with Dr Ng I recall one possibly 2 consultations with him five or six years ago . Dr Ng was Director of the Breast Clinic at that time. and regardless of whether I had consulted with him personally or not presumably the ultimate decision concerning surgical procedures would rest with him. I had a large fibroadenoma removed at Auckland Hospital in 1997 and ultrasound scans were undertaken at the hospital in 2002 and 2003.
Dr Theakston: I advised that in 1988 Dr Simpson of the University of Otage had diagnosed Myalgic Encephalomyelitis . A blood test which had established an increase in the surface changes of the cells. Mr Morten queried ( were these blood tests the same blood tests that were requested by Dr Simpson). It would seem unlikely that Dr Simpson would have made that diagnosis without the assistance of a blood test. With regard to the non-reporting of red blood cells as” general practitioners did not think it provided any useful additional information to the haemoglobin concentration” Mr Morten queried ( the relevance of this statement in relation to the first paragraph or the second or is there still additional information required?) Non reporting of the red blood cells might be considered a serious matter particularly in view of the diagnosis of red blood cell abnormalities in 1988 . In view of the fact that haemoglobin is a component of the red blood cell the non-reporting of the latter might be considered unusual if not suggestive of concealment of a disorder.
Dr Lane: In my complaint I made reference to your upper endoscopy and colonoscopy reports dated 21 May 2003 . Mr Morten stated ( who performed the colonoscopy report ? What is the relevance to the endoscopy report ? Did Dr Lane make this statement i.e. lining of the bowel attributed to the overuse of laxatives”) I think Mr Morten is being somewhat obtuse –an endoscopy examines the upper digestive area and the colonoscopy the large bowel. Advice attributing melanois coli to the overuse of laxatives was provided by both Dr Lane and on the internet from the West Shore Colonoscopy Centre in Philadelphia . I concluded my letter of complaint by stating that “ I would appreciate your explanation as to why details from earlier scans concerning mural polypi and the condition of the oesophagus were not detected” Mr Morten stated (reference to what report? Was this outlined in the endoscopy report by Dr Lane ) Mural polypi were referred to in an Auckland Radiology report of 8 April 1988 and the oesophagus in a CT scan of the lung dated 20 June 2002. Dr Lane advised that images of the endoscopy/colonoscopy procedures had not been retained at Auckland public hospital after the procedure. Mr Morten stated ( more specific questions would be relevant to why they are not retained). I don’t see quite how I could have been any more specific in my query as to the non-retention of hospital procedural.film.
Dr Marshall: Mr Morten stated ( elaborate how you felt you were discriminate) As I recall there was no significant acrimony evident during the course of the consultation. Dr Marshall seemed to take umbrage at my comments concerning gram negative bacterial infections hardly a reason to terminate the consultation. The fact that he suggested I seek medical care closer to home would seem to indicate that my presence wasn’t wanted at his practice i.e. discrimination. Dr Marshall was a Chairman of Procare and a senior member of the medical fraternity.
Dr Knill I do not have a record of the exact date of the consultation which occurred in 2004 I had incorrectly stated the year of the consultation as 2005.
Dr Corbett: I contrasted the attitude of this practitioner who during one consultation diagnosed “rales” and prescribed antibiotics with her strange comment and change in attitude in a subsequent consultation . Mr Morten seems to missed the point (what is your reasoning for the above comment in relation to the following paragraph is it because she diagnosed rales or because she prescribed antibiotics . I do not recall the exact date of the consultation however I believe it was in 2004.
Dr Julie Hancock: During a consultation with Dr Hancock in December 2004 she suggested that a reason my red blood cells had not been reported by Diagnostic Medlab was because they were being reported in an alternative way. Mr Morten commented ( are you suggesting he explain how they report this information) Obviously this was not an accurate statement by Dr Hancock as Dr Theakston the Clinical Director of Haematology at Medlab subsequently advised that reporting of the red blood cells had ceased altogether-“ because general practitioners did not think that it provided any useful additional information to the haemoglobin concentration” Mr Morten queried ( is this relevant to the complaint). Non-reporting of red blood cells might be construed as seriously negligent. .In respect of a diagnosis by Diagnostic Medlab of a gram negative bacterial infection during 2 consecutive months Mr Morton stated ( (was this by Dr Hancock). Dr Hancock provided an alternative prescription of nasal spray and paradex tablets during the consultation of June 2005. Mr Morten queried (is this what he prescribed in June). I described a comment overheard from Dr Hancock’s office as discriminatory. Mr Morten suggested that the word (disrespectful ”) might be more appropriate. I don’t agree.
Dr Dan Anderson: I attended a consultation with Dr Dan Anderson on 27 January 2006. On my way out the door at the end of the consultation Dr Anderson passed a derogatory sexual comment “ doesn’t like f….king “ Mr Morten commented ( are you certain that Dr Anderson made the
se comments) As I recall I suggested to Dr Anderson that it might be a matter for the police however my comment met with a measure of indif-ference.
Dr Van Roekel: I considered that Dr Van Roekels twice repeated “ committed” comments in the reception area of the practice was discriminatry. Mr Morten stated ( not necessarily that perhaps where unnecessary) Whatever that means!
: It is quite clear from the chronology of my text that I underwent a hysterectomy in 1988 and some 2 years later as a result of experiencing severe contractions in the groin an investigative laparascopy procedure was performed by Dr Ron Jones. Mr Morten appears to have juxtaposed the details from the laparascopy with the hysterectomy i.e. (“ a hysterectomy had been performed in 1988 and you reported “that a loop of small bowel was adherent to the stump of the right infundibulo pelvic ligament ………-do you believe that this could have contributed to the laparascopy in 1991 –further elaborate about these details) Subsequent to the laparascopy I was advised by the nurse/receptionist that I would experience only a little referred pain however the pain proved to be very severe and long lasting. Mr Morten stated (was this in 1988 or in 1991 more importantly the complaint should be directed to the Nurse in concern and more specific details would required to determine which Nurse had advised you at that time) Any complaints concerning the procedure should be directed to the gynaecologist who performed the procedure not the receptionist /nursing staff.
I also expressed concern about the closure of my complaints by a female staff member (Miss K Tu) prior to the receipt of replies from the medical providers. The stated reason was “ your complaints to the following health providers had been closed with our service-the majority of your concerns requested explanations from Doctors regarding reports written about your health concerns…I am unable to pressure or convince Health Practitioners to change what they reported on completion of examination into your health however this should not stop you from continuing your campaign to seek full explanations about your ongoing health concerns”
This attitude was later affirmed by HDC’s legal representative Ms T Baker who apparently chose to ignore salient facts and concurred with the replies of most the providers. Right 4 of the Health and Disabilty Code of Rights is advises “every consumer has the right to have services provided in a manner that minimises the potential harm to and optimises the quality of life of that consumer” Right 6 entitled the “ Right to be Fully Informed” includes an “explanation of his or her condition///an explanation of the options available ///the results of tests and procedures. “ The replies from the medical providers often tended to be evasive sometimes discriminatory and in the case of at least one respiratory physician seriously erroneous. A summation of some of these complaints are detailed below in a letter received from Theo Baker dated 23 February 2009 on behalf of the then acting HDC Commissioner Ron Paterson.
I
BIO HAZARDOUS EXPERIMENTATION
Wikipedia advised that “ From 1946 to 1953, at the Walter E. Fernald State School in Massachusetts, in an experiment sponsored by the U.S. Atomic Energy Commission and the Quaker Oats corporation, 73 mentally disabled children were fed oatmeal containing radioactive calcium and other radioisotopes, in order to track “how nutrients were digested”. The children were not told that they were being fed radioactive chemicals and were told by hospital staff and researchers that they were joining a “science club”
In another study at the Walter E. Fernald State School, in 1956, researchers gave mentally disabled children radioactive calcium orally and intravenously. They also injected radioactive chemicals into malnourished babies and then pushed needles through their skulls, into their brains, through their necks, and into their spines to collect cerebrospinal fluidfor analysis
In 1941, at the University of Michigan, doctors Francis and Jonas Salk and other researchers deliberately infected patients at several Michigan mental institutions with the influenza virus by spraying the virus into their nasal passages.[17] Francis Rous, editor of the Journal of Experimental Medicine wrote the following to Francis regarding the experiments:
“It may save you much trouble if you publish your paper … elsewhere than in the Journal of Experimental Medicine. The Journal is under constant scrutiny by the anti-vivisectionists who would not hesitate to play up the fact that you used for your tests human beings of a state institution. That the tests were wholly justified goes without saying.”
The History of Bioterrorism in America
By Richard Sanders, Coordinator, Coalition to Oppose the Arms Trade.
“Who is behind the recent spate of Anthrax attacks? Who would intentionally expose Americans to such deadly germs? To answer these questions, it is useful to know that there have been previous cases bioterrorism in the U.S. Previous incidents of bioterrorism in America since WWII, although more widespread than this year’s anthrax-related incidents, received very little media attention.

The identities of those who planned and perpetrated decades of bioterror attacks on Americans is known. Although they have admitted their guilt – in written confessions to Congress – they remain immune from prosecution. They are above the law.
In a 1977 special report to Congress, the U.S. Army admitted conducting hundreds of chemical and biological warfare tests, including at least 25 that deliberately targeted the unsuspecting public. The military disclosed evidence that it had released disease-causing germs in at least 48 open-air tests. (U.S. Army Activity in the U.S. Biological Warfare Programs, 1942-1977. Vols 1 and 2, February 24, 1977) In 1994, Senator John D.Rockefeller’s report (Examining Biological Experimentation on U.S. Military) further revealed that over the previous 50 years, the U.S. military intentionally exposed hundreds of thousands of their own soldiers to dangerous microbes, mustard and nerve gas, radiation, hallucinogens and psychochemicals.
Recent bioterror attacks have prolonged the national crisis sparked on September 11. Widespread concerns about anthrax have served those who wish to promote the draconian laws that are descending upon the U.S. Curiously, the strain of anthrax bacteria being used most likely originates from the U.S. military (Debora MacKenzie, New Scientist, October 24)

The following quotations, compiled from various sources, summarize the shameful but little-known history of the U.S. military’s responsibility for exposing Americans to the terror of biological weapons.

——————-
1943 Fort Detrick:
The U.S. began research on biological weapons at Fort Detrick, MD.1 They studied anthrax, brucellosis, Botulinus toxin, plague, Sclerotium rolfoil, late blight, late blast, brownspot of rice, rinderpest, tularemia, mussel poisoning, coccidioidomycosis, rickettsia, psittacosis, neurotropic encephalitis, Newcastle disease and fowl plague.
1945 Recruiting Nazis:
The U.S. State Department, Army intelligence and the CIA initiated Project Paperclip to recruit Nazi scientists and offer them immunity and secret identities in exchange for work on top secret, U.S. government projects [including bio-warfare experiments on unwilling human subjects].1

1946 Japanese war criminals:
The U.S. began negotiations with Japan to acquire their germ warfare data. In exchange, Japanese scientists received immunity from prosecution for their war crimes. Dr. Shiro Ishii, a physician and army officer who began experiments in germ warfare in 1932 when Japan invaded Manchuria, formed a biological-warfare unit (Unit 731) that used Chinese soldiers and civilians as test subjects. About 9,000 died of bubonic plague, cholera, anthrax and other diseases. U.S. soldiers captured in the Philippines were sent to Unit 731 so the Japanese could test biological weapons on them.2
1948 Cttee. on Biological Warfare:
The Secretary of Defense’s Research and Development Board, requested an evaluation of biological agents as weapons of sabotage. The Committee on Biological Warfare recommended that methods be assessed for disseminating biological agents, with emphasis on special operations. It recommended research to test “innocuous organisms” in ventilation systems, subways and public water supplies. This influenced administrations for 20 years and the U.S. conducted highly-classified scientific tests on unknowing populations throughout the country.

The biological warfare research program in the early 1940s and 1950s involved antipersonnel, anticrop and antianimal studies. Field trials included open-air vulnerability testing, and contamination of public water systems with live organisms such as Serratia marcescens. Covert programs were conducted by the CIA. Pathogenic organisms were tested in Florida and the Bahamas in the 1940s. Chemical anticrop studies evaluated defoliation and crop destruction.

1949 Germ bombs:
Explosive munitions tests with pathogens were begun.
1950 The First “open air tests”:
The first open-air tests with biological agents were conducted in various locales, including off the coast of Norfolk, Virginia.
1950 Spraying San Francisco:
The first large-scale, aerosol test was conducted in San Francisco Bay in September 1950, using two species of bacteria (Bacillus globigii and Serratia marcescens). Many experiments used various Bacillus species because of their similarities to B. anthracis.3
On September 26 and 27, 1950, the U.S. Army sprayed S. marcescens from a boat off the coast. On September 29, patients at San Francisco’s Stanford University Hospital began appearing with S. marcescens infections.4 Many residents came down with pneumonia-like symptoms and one died. A military, follow-up study showed that nearly every single exposed person became infected with the test organism.
The death of Edward J. Nevin was associated with this release of S. marcescens.4 (The first lawsuit against the U.S. government was filed by his family [in 1981]. The court decided that the U.S. government could not be sued, under the Federal Tort Claims Act, since the decision to spray S. marcescens was a part of national defense planning.)

1951 Racist Germs:
Army researchers deliberately exposed a disproportionate number of black citizens to the fungus Aspergillus fumigatus, to see if African Americans were more susceptible to such infection, like they were already known to be to coccidioidomycosis (Coccidioides immitis). Similarly, in 1951, unsuspecting [black] workers at the Norfolk Supply Center, Norfolk, VA, were exposed to crates contaminated with A. fumigatus spores.3
1955 Whooping Cough:
Tampa Bay, FA, experienced a sharp rise in Whooping Cough cases, including 12 deaths, following a CIA bio-war test in which bacteria from the Army’s Chemical and Biological Warfare arsenal was released to the environment.5

1951-1969 Dugway Proving Ground:
Hundreds, perhaps thousands, of open-air tests using bacteria and viruses that cause disease in human, animals and plants were conducted at Dugway Proving Ground, a military testing facility about 80 miles from Salt Lake City, Utah. These tests were to determine how the agents spread, survive and effect people and the environment.
It is unknown how many people in the vicinity were exposed to potentially harmful agents during these open-air tests. In 1969, concerns were expressed at a congressional hearing about the possible public health implications of the VEE virus tested there.
University of Utah scientists and doctors are greatly concerned about the potential health consequences not only for military personnel who work and train at Dugway, but also for civilians who live in a nearby small town and Indian reservation. Utah Medical Society physicians complained about the lack of information provided to the medical community.According to Rutgers University political science professor Dr. Leonard Cole, the use of potentially harmful chemical and biological agents continues at Dugway. He testified that the U.S. Army uses Bacillus subtilis “which is is recognized as a potential source of infection and can cause serious illness in some people when they are exposed to it in large numbers and they inhale large numbers of those microorganisms.”4
Mid1950s-early 1970s Project Shad:
The Dugway Proving Ground and Fort Douglas had a secret navy, called Project Shad. Their ships sailed through clouds of germ and chemical agents. Some sailors blame these tests for the cancer and other diseases that they suffer from.6
1956 Operation Transit III:
One of Project Shad’s first tests occurred in San Francisco Bay as part of Operation Transit III. In September 1956, plans called for a 40-foot munitions boat to create clouds of Bacillus globigii germs that the Eastman would travel through. Plans called for enough germs to ensure that “a minimum respiratory dose of 10,000 organisms is received on deck.” Planners considered B. globigii a safe “simulant” of more dangerous germs. (The U.S. Army still uses it for field testing.)
The tests included dropping “20,000 gallons of BG (B. globigii) slurry” from helicopters.
1956 to 1958 Testing on Blacks:
The U.S. Army did field tests in the poor black communities of Savannah, Georgia, and Avon Park, Florida, in which mosquitoes were released into residential neighbourhoods from ground level and from planes and helicopters. Many were swarmed by mosquitoes and developed unknown fevers; some even died. After each test, Army personnel posing as public health officials photographed and tested the victims and then disappeared from town. It is theorized that the mosquitoes were infected with a strain of Yellow Fever. Details of the tests remain classified.5
1950s to 1970s Operation Whitecoat:
Many experiments that tested various biological agents on human subjects, referred to as Operation Whitecoat, were carried out at Fort Detrick, MD. The human subjects originally consisted of volunteer enlisted men. However, after the enlisted men staged a sitdown strike to obtain more information about the dangers of the biological tests, Seventh-Day Adventists who were conscientious objectors were recruited for the studies. Because they did not believe in engaging in actual combat, they became human subjects in military research projects that tested various infectious agents. At least 2,200 Seventh-Day Adventists were used in biological testing during the 1950s through the 1970s.
1962 More on Project Shad:
Training outlines show that Project Shad sailors were briefed on work with germs causing some of the deadliest diseases known, including tularemia, anthrax, parrot fever, Q fever, African swine fever, the plague and botulism.
1963-1965 Project Shad ships “participated in 111 tests” using nerve agents GB and VX, and biological agents Bacillus globigii, Serratia marcescens and Escherichia coli. (Letter from Maj.Gen. L.J.Del Rosso, Army director of space and special weapons, to Senator Steve Symms, R-Idaho, 1992)

1966 New York Subway:
From June 7-10, the U.S. Army’s Special Operations Division dispensed [Bacillus subtilis var niger3] throughout the New York City subway system. The Army’s justification for the experiment was the fact that there are many subways in the USSR, Europe and South America. Details of the experiment are still classified.5 More than a million were exposed when army scientists dropped lightbulbs filled with the bacteria onto ventilation grates.
1987 Continued Research:
The Department of Defense admitted that, despite a treaty banning research and development of biological agents, it continues to do research at 127 facilities and universities in the U.S.1”

In 1955, the CIA conducted a biological warfare experiment where they released whooping cough bacteria from boats outside of Tampa Bay, Florida, causing a whooping cough epidemic in the city, and killing at least 12 people.
In 1953, the CIA placed several of its interrogation and mind-control programs under the direction of a single program, known by the code name MKULTRA, after CIA director Allen Dulles complained about “not having enough human guinea pigs to try these extraordinary techniques”.[113] The MKULTRA project was under the direct command of Dr. Sidney Gottlieb of the Technical Services Division.[113] The project received over $25 million, and involved hundreds of experiments on human subjects at eighty different institutions.
In a memo describing the purpose of one MKULTRA program subprogram, Richard Helms said:
We intend to investigate the development of a chemical material which causes a reversible, nontoxic aberrant mental state, the specific nature of which can be reasonably well predicted for each individual. This material could potentially aid in discrediting individuals, eliciting information, and implanting suggestions and other forms of mental control.
—Richard Helms, internal CIA memo
In 1954, the CIA’s Project QKHILLTOP was created to study Chinese brainwashing techniques, and to develop effective methods of interrogation. Most of the early studies are believed to have been performed by the Cornell University Medical School’s human ecology study programs, under the direction of Dr. Harold Wolff.[101] HYPERLINK “http://en.wikipedia.org/wiki/Human_experimentation_in_the_United_States”%5B115%5D HYPERLINK “http://en.wikipedia.org/wiki/Human_experimentation_in_the_United_States”%5B116%5D Wolff requested that the CIA provide him any information they could find regarding “threats, coercion, imprisonment, deprivation, humiliation, torture, ‘brainwashing’, ‘black psychiatry’, and hypnosis, or any combination of these, with or without chemical agents”. According to Wolff, the research team would then:
…assemble, collate, analyze and assimilate this information and will then undertake experimental investigations designed to develop new techniques of offensive/defensive intelligence use … Potentially useful secret drugs (and various brain damaging procedures) will be similarly tested in order to ascertain the fundamental effect upon human brain function and upon the subject’s mood … Where any of the studies involve potential harm of the subject, we expect the Agency to make available suitable subjects and a proper place for the performance of the necessary experiments.
—Dr. Harold Wolff, Cornell University Medical School
Details of Pseudomonas Fluorescens are as follows: Chemtrail Sky Samples Analyzed
By William Thomas with Erminia Cassani
http://educate-yourself.org/ct/ctarticle12.shtml
April 21, 1999
VICTORIA, British Columbia, Canada, April 21, 1999 (ENS) – As unmarked tanker-typeaircraft continue spraying sky-obscuring chemtrails over regions of the U.S. and Canada,this writer and American journalist Erminia Cassani have obtained laboratory tests of fully documented samples of aerial fallout.
The samples were tested by aU.S.Environmental Protection Agency (EPA) licensed facility. The two samples were taken from aluminum-sided structures in separate states nearlya year apart after their respective owners went outside in the wake of low-flying aircraft to find dwellings and outbuildings splattered with a brown, gel-like substance.
Trained in the health sciences, Cassani carefully took samples from the second incident which occurred at 2:00 pm on November 17, 1998. The samples were taken from property directly under the flight approach path to Thomasville airport, an old airport once used for commercial flights but now used only for small planes. This facility is located a 45 minutes drive from the Harrisburg International Airport in Pennsylvania.
Noting nearby military hangars filled with big helicopters, Cassani videotaped a house splattered on all sides, as well as the driveway. The reporter also interviewed a man living near the main runway who claimed that a similar goo had hit his house the previous October. Cassani became ill with flu-like symptoms and was sick for four days after obtaining the sample. When a marine biologist at a nearby university started working with the gel material, he too immediately developed upper respiratory symptoms. The woman whose house had been struck also caught the”flu.” Two weeks before Christmas 1998 she suffered a heart attack.
Coliform tests by the state Department of Health were negative. But when the university Ph.D. biologist turned his microscope to high power, he found the glass slide teeming with a protozoan life form he said was “very resilient to very cold temperatures.” The laboratory staff who eventually received our sample for a complete analysis had never seen cell cultures bloom so fast. Cell cultures normally take several days to grow; ours flowered into brilliant colors within 48 hours of being placed in petri dishes. Exclaiming that, “It was all over the plate,” the biologist who examined our first sample wanted to know where we had obtained this “bio-hazard” material.
No markers for jet fuel were evident. But the TNT and fuel-eating Pseudomonasfluorescens found in our sky sample is listed in 163 Pentagon patents for bioremediation. Sometimes employed against oil spills, Pseudomonas fluorescens can consume jet fuel as a primary food source. This bacteria can cause upper respiratory illness and serious blood infections in humans.
Serratia marcescens was found in yet another gel sample obtained in Idaho in late March, 1999. Often causing upper respiratory infections resulting in pneumonia, Serratia marcescens was sprayed into the New York subway system in 1953, and over Dorset, England from early 1966 to 1971 by the military in both countries. Serratia marcescens was supposedly withdrawn as a biological warfare stimulant in the 1970s when this infectious agent was deemed too hazardous for use on friendly test populatioE.coli, Serratia marcescens, and Bacillus globigii were sprayed over UK population centers to stimulate bio warfare attacks in the 1960s and 1970s, the London Telegraph reported in May of 1998. All three agents can cause disease in humans including pneumonia and chest infections. According to recent admissions by the British Defense Ministry, a Canberra jet bomber was modified with spray tanks to “attack as a spray aircraft for research into defence against biological warfare.”
Serratia marcescens was used by the American Army for experimental purposes over San Francisco in the 1950s. There was a significant increase in both respiratory urinary infections thereafter. The same bacteria also contaminated the American flu vaccine of 2004.’
Mr Graeme Malaghan, a businessman, who is the Chairman of the Malaghan Biomedical research institute in Wellington, resides in an adjoining street in St Heliers . A former resident of St Heliers was an Iranian woman Hideh Harger who previously taught biological sciences at the international school in Jakarta Indonesia. She owned a small local shop specialising in Iranian imports and on one or two occasions and was prone to making comments of a sexual nature while standing beside me in the local supermarket. ESL biosciences is also located in St Heliers. Another local woman Dr Adriana Gunder has a doctorate in biological sciences and is a member of the national ethics advisory committee. In 2005 an Iraqi local resident Mrs Hamdi advised the local press that her son, a microbiologist, had secured a work permit for New Zealand. Soviet microbiology might also be relevant-there is a soviet group resident in the neighbourhood.
A neighbour in Whangarei was also apparently involved in a bio experimental program controlled by an individual possibly named Kissling. Anthrax and diptheria were 2 diseases mentioned in the short wave transcripts in respect of Melitia (?) nee Jenkins. Melitia had experimented on her cats two of which had shaved areas on their legs-the one an inverted triangular shaved area with a classic split lip and the other a small round area with what appeared to be a light coloured pustule. Photos were sent to the Whangarei SPCA. The number of cats was also increased and they seemed to spend most of their time outside. 2 cats would sleep in my unit at night from time to time I fed 4 of Melitias cat twice a day for 12 months.
RESPIRATORY
Addtional health problems began in Wellington in the early 1980s . I had been unemployed for approximately 18 months. I was first afflicted with a cloracne type condition affecting the lower portion of both legs .A prescription cream proved to be almost useless and the condition disappeared the next summer. I don’t recall any specific any specialist diagnosis however it is quite probable that that condition was erythema nodosum (sometimes indicative of sarcoidosis and /or TB) . The following year I experienced sudden pains in the side of the neck coupled with blocked and painful ears together with pain extending down the left side of the body and subsequent extreme exhaustion after exertion. A dark red discolouration (erythema palmar) appeared under the skin at the edge of both hands. There was neither medical diagnosis nor treatment . This particular condition has been shown to a number of medical practitioners in subsequent years but has otherwise been ignored apart from a comment from a gastroenterologist !
I have been afflicted with severe chest and sinus infections for approximately 40 years- first diagnosed in the early 2000s. In recent years I have been diagnosed with different gram negative bacteria often in conjunction with gram positive strains. They include Pseudomonas Aeruginosa with which I have been almost exclusively afflicted in recent years. Other pathogens include Serratia liquefaciens. Serratia marcescens Stenetrophomonas maltophilia. Pseudomonas Fluorescens Haemophilus Influenzae and in August 2011 Streptococcus Pyogones. S Maltophilia has been described as “opportunistic-infecting patients with predisposing risk factors including malignancy” Serratia marcescens was used by the American Army for experimental purposes over San Francisco and elsewhere in the 1950s. There was a significant increase in both respiratory urinary infections thereafter. The same bacteria also contaminated the American flu vaccine of 2004.

Details of pathogens with which I have been afflicted are as follows:
Date 7/3/2003: Heavy growth pseudomonas aeruginosa and Serratia liquefaciens 4//4/2005 heavy growth of serratia marcescens /////////3/5/2005 large nos of gram negative bacilli//////25/1/2006 Heavy growth of Stenotrophomo-nas maltophilia/////// 6/1/2007 Heavy growth of serratia liquefaciens//////30 /7/2009 Heavy growth of pseudomonas fluorescens///////24/11/2009 moderate growth of haemophilus influenzae///////24/8/2009 No acid fast bacilli seen no mycobacteria species isolated after six weeks//////9/7/2010 large nos of gram negative bacilli small nos of gram positive bacilli//////27/8/2010 heavy growth of non-fermenting gram negative bacilli////4/3/2011 mixed gram negative organisms////31/8/2011 Streptococcal antibodies ASOT 116 IU/mL (<240)- aDNase B 600U/mL(<200)H Interpretative range aDNase 200-680 equivocal
24/1/2013 large nos of epithelial cells- large nos of gram negative bacilli –mixed gram negative organisms/// ////16/5/2013 large nos of gram positive cocci- small nos of gram positive bacilli- and small nos of gram negative bacilli///////2/9/2013 large nos of gram negative bacilli- small nos of gram positive bacilli- large nos of gram positive cocci-heavy growth of psesudomonas species////////24/2/2014 large nos of gram negative bacilli heavy growth of pseudomonas species////11/9/2014 large nos of gram negative bacilli heavy growth of pseudomonas species//// 21/10/014 large nos of gram negative bacilli small nos of gram positive cocci small nos of gram positive bacil-li////////31/12/2014 Fungal culture of sputum : no fungal elements seen: TB culture : no acid fast bacilli seen -no mycoba////bacteria isolated after six weeks/////////3/3/2015 Large nos of gram negative bacilli moderate nos of gram positive cocci-heavy growth of pseudomonas species////////3/7/2015 large nos of gram negative bacilli small nos of gram positive cocci -heavy growth of pseudomonas species/////// 5/9/2015 large nos of gam negative bacilli -heavy growth of pseudomonas species////////16/12/2015 Large nos of gram negative bacilli small nos of gram positive bacilli heavy growth of pseudomoas species////////23/2/2016 Large nos of gram negative bacilli heavy growth of pseudomoas species/////4/1/2017 Large nos of gram negative bacilli light growth of pseudomonas species///////
27/3/2017 Large nos of gram negative bacilli -mixed gram negative organisms/////15/5/2017 Large nos of gram negative bacilli small nos of gram positive bacilli heavy growth of pseudomonas species//////////4/7/2017 Large nos of gram negative bacilli small nos of gram positive bacilli heavy growth of pseudomonas species////26/7./2017 moderate nos of gram positive cocci- small nos of gram negative bacilli- small nos of gram positive bacilli culture:-growth of respiratory flora?//////////28/8/2017 large nos of epithelial cells- Large nos of gram negative bacilli-small nos of gram- positive cocci – heavy growth of pseudomoas species////////2/10/2017 moderate nos of epithelial cells Large nos of gram negative bacilli-small nos of gram- positive cocci – mixed gram negative organisms////////15/12/2017 small nos of epithelial cells Large nos of gram negative bacilli-small nos of gram- positive cocci -occasional gram positive bacilli-mixed gram negative organisms//////////
5/1/2018 No streptococci A C G or Arcanobacterium isolated///////27/1/2018 moderate nos of gram positive cocci moderate nos of gram negative bacilli -mixed gram negative organisms////////19/2/2018 Large nos of gram negative bacilli—heavy growth of pseudomonas species////////7/3/2018 moderate nos of gram positive cocci small nos of gram negative large nos of gram negative bacilli bacilli-mixed gram negative organisms///////20/3/2018 large nos of gram negative bacilli heavy growth of pseudomonas species/////////20/4/2018 moderate nos of gram positive cocci/////// large nos of gram negative bacilli- heavy growth of pseudomonas spe-cies///////18/5/2018/////// moderate nos of epithelial cells large nos of gram negative bacilli occasional gram positive cocci////////19/6/2018 large nos of gram negative bacilli small nos of gram positive cocci- heavy growth of pseudomonas species//////20/7/2018 large nos of gram negative bacilli small nos of gram positive cocci- heavy growth of pseudomonas species//////20/7/2018 large nos of gram negative bacilli small nos of gram positive coc-ci////////14/9/2018 moderate nos of polymorphs and epithelial cells mixed organisms predominantly gram negative bacillus-heavy growth of pseudomonas specie 28/12/2018 s/////////18/2/2019 mixed organisms predominantly gram negative bacillus-culture growth of respiratory flora////// 28/12/2018 large nos of polymorphs and small nos epithelial cells- mixed organisms predominantly gram negative bacillus heavy growth of pseudomonas spe-cies//////8/4/2019 mixed organisms predominantly gram negative bacillus/////27/5/2019 mixed organisms predominantly gram negative bacillus heavy growth of pseudomonas species///////14/10/19 Culture : Mixed gram negative organisms seen predominantly gram negative coccus? ( Wikepedia advises : “Medically relevant gram-negative cocci include , a meningitis (Neisseria meningitis) and respiratory symptoms (Moraxella catarrhalis, Haemophilus influenzae”.)// 7/12/2019 Mixed organisms predominantly gram negative bacillus-culture mixed gram negative organisms//////
9/1/2020 Mixed organisms no predominant organism seen culture: growth of respiratory flora including mixed gram negative organisms//20/11/2020 Heavy growth of serratia liquefaciens////18/3/ 2021 Throat Swab Labtests: “Group A Strep not detected. Culture: No beta-haemolytic streptococci group A C and G or Arcanobacterium isolated//////3/6/2021 heavy growth of serratia species//////2/8/2021 Moderate nos of epithelial and polymorphs-heavy growth of stenotrophomonas maltophilia -mixed organisms predominantly gram negative////12 /10/2021 small nos of polymorphs and epithelial cells-mixed organisms predominantly gram negative bacillus ///12/11/2021 Nasopharyngeal Sars-Cov-2 not detected///16/2/2022 small numbers of polymorphs -moderate numbers of epithelial cells -mixed organisms predominantly gram negative bacillus///////5/5/2022 Growth of respiratory flora-including mixed gram negative organisms//////8/8/2022 moderate numbers of polymorphs seen occasional epithelial cells-mixed organisms seen predominantly gram negative bacillus-culture growth of respiratory flora including mixed gram negative organisms/// 2/8/2022 no polymorphs seen moderate nos of epithelial cells mixed organisms seen predominantly gram positive coccus /////// 9/9/2022 mixed organisms no predominant organisms seen////19/9/2022 mixed organisms no predominant organism seen culture growth of respiratory flora//// 25/10/2022 Mixed organisms predominantly gram negative bacillus culture growth of organisms predominantly mixed gram negative organisms.//22/11/2022 Mixed organisms predominantly gram negative bacillus culture growth of respiratory flora-including mixed gram negative organisms ///////9/1/2023 and 26 /1/2023 growth of respiratory flora-including mixed gram negative organisms/////17/2/2023 mixed organisms seen predominantly gram negative bacillus heavy growth of pseudomomas species susceptibilities ciprofloxacillin ceftazidime /////////16 /4/2023 Mixed organisms heavy growth of pseudomonas species.
For many years I have been afflicted with severe sinus and chest infections. On one occasion over 20 years ago a GP diagnosed pleurisy. Shortly after my arrival in Sydney in the early 1980s I was afflicted with the most potent chest and sinus infection I had ever experienced which almost caused me to almost lose consciousness and affected my balance. I was confined to a motel room for 2-3 weeks taking prescribed antibiotics.
Chest x-rays of 1989 and 1991 reported ‘over expanded lung space commensurate with chronic obstructive airways disease”. This was somewhat contradicted as a result of later specialist spirometry testing. A study of peak flow and expiratory scans indicated small airways disease. “The diaphragm was not flattened and as I had only 2.5 metres of air in front of the aortic arch the lungs were not categorised as being over expanded although I did have 6 1/ 2 ribs exposed anteriorly” CT scans of 1999 reported “several lymph nodes lying adjacent to the main trachea however there was considered to be no pathological lymphadenopathy”
.In 2001 I was afflicted with a particularly severe but undiagnosed chest infection. A senior respiratory physician Dr Pardy) at public hospital appeared to be indifferent and referred me back to my GP. He also suggested that the CT scans could be discontinued . However in a report dated March 2002 Radiologist David Milne recommended “ that further consideration could be given to a further examination in 12 months time” As I was concerned about Pardy’s verbal recommendation I then decided to attend an alternative respiratory physician Professor Garrett in a private capacity .
A report dated 20 June 2002 stated “very minor atelectasis in the right medial aspect of the right middle lobe and the lingular segment of left upper lobe . Fluid is seen within the oesophagus which is a little thick-walled. There is no pleural fluid or mediastinal lymphadenopathy.”
In 2002 respiratory physician ( Professor Garrett) performed spirometry testing which indicated small airways disease i.e. “ bronchiolitis cum asthma” In 2002 “the peak flow was 370 litres per minute which although low is within the normal range…..couldn’t maintain a particularly good forced vital capacity manoeuvre but neverthless FEV1 was 2.71 litres which is well within the normal range…there was no downward scalloping of the expiratory flow volume loop as would be expected in someone with obstructive disease.The diaphragms are not flattened and as I had only 2.5 metres of air in front of the aortic arch the lungs and therefore does not fulfil criteria for over-expansion though she does have 6 1/ 2 ribs exposed anteriorly
I revisited Dr Garrett on 18 March 2003 subsequent to a consultation with Dr Mike Holton at A and E medical in Kohimarama. A sputum test was undertaken which diagnosed a combination of 2 gram negative pathogens serratia liquefaciens and pseudomonas aeriginosa which might be indicative of double pneuomonia..I was afflicted with these pathogens for almost 6 months. The sputum was dark green in colour. Holton gave me the alternative of having IV treatment at the hospital or receiving treatment with Ciprofloxacillin. I selected the latter. In his letter of 18 March Garrett advised that I had received benefit from long courses of antibiotics namely Cotrimoxazole and Romicin. That obviously was not the case and was obviously the reason I had requested a test from Dr Holton. Garrett further advised I have therefore arranged for cystic fibrosis genotyping and embarked on a trial of cipro. “It is possible that Vicki will derive some improvement in symptoms only for them worsen off cipro. Should this occur I would revert back to Romicin and Co-trimoxazole for 3-6 weeks rather than extending the Cipro as the latter option would increase her susceptibility to developing Ciprofloxacillin resistance. Obviously I had not improved on Romicin or Co-Trimoxazole and if I had selected the hospital option drugs would most probably have been those recommended by the British The Lancet (25/10/2021) which advises “Serratia infections should be treated with an aminoglycoside plus an antipseudomonal beta-lactam, as the single use of a beta-lactam can select for resistant strains. Most strains are susceptible to amikacin, but reports indicate increasing resistance to gentamicin and tobramycin..As an alternative Levofloxacin tablets are sometimes indicated for the treatment of nosocomial pneumonia due to methicillin-susceptible Staphylococcus aureus, Pseudomonas aeruginosa, Serratia marcescens. In his letter dated 15 April Garrett advised Vicki told me that with the course of Cipro she felt somewhat better-she had reverted back to Romicin and ddn’t notice any difference in symptoms-results of cystic fibrosis genotyping were negative. I suggest that Vicki continue with Romicin over the winter period before trialing herself off the treatment. I will see her again in a years time. ‘Garretts assessment would seem to have been erroneous

In May 2004 respiratory physician Dr Kolbe advised “–she has no known allergies and has no significant exposures” and claimed that “that the presence of this organism(aeruginosa) is often associated with antibiotic use and it is likely that this generally resistant organism is selected out by antibiotic use….the best course of action would be to stop all antibiotics Under the circumstances of chronic airway colonization the Pseudomonas Aeruginosa very, very, seldom invades and thus systemic anti-pseudomonal antibiotics are generally not indicated in the non-CF population, even during periods of exacerbation”
This assertion would seem to be at odds with the assessment of an American bacteriologist Kenneth Todar of the Madison Department of Bacteriology at Wisconsin University who stated that “ pseudomonas aeruginosa was toxinogenic invasive and notorious for its resistance to antibiotics and almost never infects uncompromised tissue.It almost exclusively affects those who are compromised in their defence mechanisms or lower lobes . . Pseudomonas aeruginosa causes meningitis and brain abscesses. The organism invades the CNS from a contiguous structure such as the inner ear or paranasal sinus, or is inoculated directly by means of head trauma, surgery or invasive diagnostic procedures, or spreads from a distant site of infection such as the urinary tract.”
Incorrect biographical details began to be evident in reports. In 2004 Physician Dr Whyte advised “no history of significant childhood chest problems///she denies major problems with rhinosinusitis”….. He continued: “that the culturing of an out of the ordinary bacteria in a patient who has received many antibiotics does not prove that the out of the ordinary bacteria is doing any harm… the presence of antibiotics can inhibit the growth of bacteria on the culture plate leading to other innocent bacteria growing and being mistaken for the culprit” One would assume that if the strain is virulent it would be predominant and the likelihood of innocent bacteria being mistaken for the culprit would be remote .
Prior to bronchoscopy in 2004 respiratory physician (Professor Garrett) advised that “a bronchoscopy would also allow us to do a BAL which would allow us to better understand the inflammatory cells present within her lower airways and allow a more pure collection of mucus from the lower airways for bacterial culture. I would undertake a bronchial biopsy to assess whether she has inflammation within her airways” The subsequent Hospital bronchoscopy report stated “that there was no evidence of bronchitis so no biopsies attempted . No evidence of bronchitis or sinusitis”
There was some bleeding from the lungs ( not entirely abnormal after this procedure). The specialist concerned was not present immediately after the procedure –I was left in the care of the nurses. The bleeding from the lungs was not referred to in the specialist’s report –there was only one notation namely that “ I tolerated bronchoscopy well-I had bronchitis and requested antibiotics”( which contradicts the hospital report) The day after bronchoscopy I was in fact afflicted with a chest infection producing coloured sputum. Specialist’s bronchoscopy report advised that there was “no evidence of inflammation or mucous in the airways” The two sputum samples-the one as a result of the lavage and the other the following day were at variance i.e Medlab report for the former indicated “no white cells organisms nor epithelial cells” while the the lab report for the latter indicated “mixed bacterial flora large number of white cells and a heavy growth of normal respiratory flora Although no pathogen were specified the white cell count is in itself indicative of infection. There were a few bright pin pointed areas evident in the trachea adjacent to the bronchi which may be significant?
The bronchoscopy report continued – “that cell differentials were normal the results are against chronic infection in view of the fact that the neutrophils are not elevated” Lavage results indicated that there was a difference in the neutrophil levels between the left and right lungs i.e. 31% ( 0.31) in the left and and 72% ( 0.72) in the right A decreased percentage of neutrophils can indicate overwhelming infection and aplastic anemia. Lymphocytes in the left lobe were 9% and 10% in the right. A significant decrease in lymphocytes might indicate HIV infection, leukemia Radiation or sepsis.
“Bronchial epithelial cells were 58% in the left and 14% in the right. Photos from the bronchoscopy included, the vocal chords. bifurcation of the trachea and the origin of the right lower lobe only. Photos of the bronchoscopy did not include a photo of the left lower lobe – the specialist’s written explanation concerning the missing photo advised “that the left lower lobe was normal and no photograph was taken. The right was photographed just to show you how normal the appearance was in general’ Prior to bronchoscopy the physician initially expressed concern about the contamination of the lower lobes but was subsequently at a loss to explain further infection . The entire bronchoscopic procedure is now available on YouTube.
I visited Respiratory Physician in Dr Christmas in November 2007 . He expressed some concern about the gram negative bacterial infections however he regarded the oropharyngeal flora to be the main culprits The four gram negative bacteria have been cultured from chest sputum have resulted in some quite severe chest infections . I was also concerned that in view of the gram negative infections an underlying condition might be responsible e.g. in the case of Pseudomonas Aeruginosa it exclusively affects patients who are compromised in their defence mechanisms or lower lobes . The respiratory physician stated that he “ agreed that it i unusual to have these sorts of organisms in immunocompetent hosts but the reports would suggest these are mostly oropharyngeal flora and the only procedure which is sampled from the lower airways has not grown these organisms so I suspect that they are in fact predominantly oral contaminants” ?
I assume that the procedure referred to was a bronchoscopy which was undertaken in 2004. In fact I was afflicted with a chest infection the day after the bronchoscopy however there was no identification of any specific bacteria. The lack of diagnosis on that occasion coupled with the fact that there is frequently oropharyngeal flora contamination in my chest sputum samples should not detract from the fact that I have a history of serious chest infections ranging in intensity from low grade to severe with accompanying head /neck/ chest/sinus pain with congestion ,significant sputum and generalised severe inflammation
A high resolution CT scan of the chest was undertaken at Ascot Hospital on 7 January 2008 reported that “ there was no evidence of bronchiectasis nor small or large mucous plugging . There was mild bronchial wall thickening.-also minor patchy decreased attenuation involving less than 10% of the volumes of both lower lobes –no mediastinal abnormality –no evidence of gastro-oesophageal reflux. An 8 mm slightly lobulated nodule in the lateral basal segment of the right lower lobe has radiologically benign characteristics –it may have a small hilum increasing the chance that the nodule is a lymph node. Mild bronchitis and minimal functional small airway disease-no other specific cause for cough is seen. A limited surveillance scan was recommended for 6-9 months” A solitary nodule can sometimes be indicative of sarcoidosis.
On 24 July 2009 I consulted with Respiratory Physician Margaret Wilsher. While there was no mention of my smoking history of 20 years in her report her assessment of my history was generally correct. In respect of the discomfort that I have experienced in the left side of the chest during infection Ms Wilsher advised “Miss Wilson admits that one of her most depressing symptoms is of the left inframammary chest pain which although not typical of pleuritic pain is worse when she has chest infection. The pain always recurs in the same place and is not associated with haemoptysis. She has had this for many years and no explanation and hence no treatment has ensued. “On examination she presented as a well looking lady of flat effect.”
( Note: a General Practitioner once diagnosed Pleurisy in Wellington in the 1980’s. Crackles and rales( specific sounds indicative of pleurisy) have been reported once or twice as a result of stethoscope examinations by general practitioners in Auckland. One practitioner thought he detected a “ dullness” on the left side.
Wilshers comments concerning my thyroid condition seem to be somewhat contradictory “She takes carbimazole for hyperthyroidism under the supervision of Brandon Orr Walker ….she was clinically euthyroid and there were no signs of Grave’s disease. In 2007 I was diagnosed by Orr Walker with “thyrotoxicosis probably secondary to autoimmune thyroid disease ( probably Graves disease) She was not clubbed. Oxygen saturation was normal (96%) predicted and auscultation of the chest revealed no findings of note ( I am frequently afflicted with lung congestion however sputum is generally produced on a daily basis). There was no spontaneous cough. She is in sinus rhythm rate 80 blood pressure 140/85 with dual heart signs the JVP is not raised . Her spirometric lung volumes are normal with an FEV 1/FVC of 2.34 /2.72 litres and her peak flow rate is normal.” ( normal predicted values for a 60 year old woman of 168 cm in height are FEV1 2.75/FVC 3.55) I am afflicted with chest sputum on an almost continuous basis however this was not apparently detected in Wilsher’s examination
There has always been a disparity between the oxygen saturation levels, the spirometric results and the readings of the more rudimentary peak flow meter undertaken at the local medical practice which has often been recorded in the early 300’s. ( Normal peak flow values would seem to range from the late 300’s to mid 400’s) The minor atelectasis (collapse ) in 2 areas of the lung were briefly discussed –Wilsher did not think the condition was entirely abnormal after a history of asthma/bronchitis. She did not refer to the condition in her report. I pointed out to Dr Wilsher what appeared to be a disparity in the cell levels in the broncoscopy procedure undertaken in 2004 by Dr J Garrett. In particular I referred to bronchial epithelial cells 14% in the right and 58 % in the left- also the neutrophils 72% in the right and 31% in the left . Lymphocytes were 10% in the right and 9% in the left.
The subheading on the Medlab report clearly specifies “cytology-bronchoalveolar lavage right and left lower lobes”. Ms Wilsher reported “ bronchoscopy undertaken by Jeff Garrett showed no anatomical abnormality and no excess secretions . There were some excess neutrophils in the wash but I pointed out to Miss Wilson that this was not a bronchoalveolar lavage and thus differential cytology is of less value”!!! Dr Wilsher clearly ignored any disparity in the cell levels between the left and right lungs and quite incorrectly claimed that the differential cytology was not part of a bronchoalveolar lavage when it was quite clearly annotated as such in the Medlab report.
With regard antibiotic treatment for chest infections Wilsher virtually reiterated the opinion of Dr Whyte a respiratory of the same practice. “we know that even normal individuals will eventually have replacement of normal respiratory flora with gram negative pathogens following heavy use of multiple courses of antibiotics” In respect of gram negative pneumonic strains medical websites advise that patients afflicted with these types of pathogens are compromised in some way either in their lower lobes or defence mechanisms. One might assume that a previous history of bronchitis asthma and some 20 years of smoking might have been considered pertinent in this regard. Unlike her counterparts Wilsher did not refer to my history of smoking in her reports. She advised “that one needs to be judicious in the prescription of antibiotics …shorter courses of simple broad spectrum antibiotic are just as likely to be effective.”
Gram negative bacterial infections are notoriously antibiotic resistant and a specific regime of drugs (including intraveneous Gentamicin) are generally recommended by Medlab At this late stage and with a current history of permanent chest infections and with resistance an obvious problem one would have considered that containment /treatment would be the priority and to that end longer courses of antibiotic would be necessary. A sputum specimen result dated 30 July 2009 reported a diagnosis of pseudomonas fluorescens with the recommended antibiotic treatment of Ciprofloxacillen or Gentamicin.
The test was requested by Dr Wilsher and presumably she received the result . She did not see fit to send me a script for antibiotic treatment. I emailed her on 13 August requesting same. Despite the Medlab report which stated a “ heavy growth of Pseudomonas Fluorescens” Dr Wilsher stated in a letter dated 17 August 2009 that “antibiotics are not recommended on the basis of sputum culture results alone and frequent use of antibiotics will not eradicate Pseudomonas and will only result in the growth of increasingly resistant and atypical organisms….if you have a change in symptoms then it may be that you have an exacerbation but if you symptoms are unchanged then the benefits of antibiotics are less clear and the risks may well outweigh such.”
I don’t know what alternative diagnosis Ms Wilsher might be referring to in respect of obtaining a diagnosis but a heavy bacterial growth would surely equate with significant infection. Why else would the laboratory also recommend specific drug treatment ? When I first consulted Wilsher on 24 July I had congestion in the lungs, pain in the left lung and pains in the neck and head. The sputum was viscous, impacted and yellow/ golden in colour
A study by the Respiratory Institute of the University of Milan in 2004 advised thus: “Our study indicates that purulent sputum is strongly associated with bacterial growth in COPD exacerbations. Deepening sputum color (from yellowish to brownish) was associated with increased yield of Gram negative and P. aeruginosa/Enterobacteriaceae”. Another sputum sample yellow/golden in color, some of which appeared to be viscous and was adhering to the side of the plastic receptacle, was analysed by Labtests on 24 August 2009 . Microscopy reported “ no acid fast bacilli seen”!
Ms Wilsher should have provided a script for antibiotics after receiving the sputum result on the 30 July and particularly as I have a heart condition –my blood pressure was recorded as 170/98 in July 2009 and 170/90 in August 2010. Wilsher advised “regrettably I do not offer a prescription service without seeing the patient….this is poor clinical practice……if you have an exacerbation that requires the antibiotic then I am happy to see you and evaluate the situation-alternatively you can see your regular practitioner” A second consultation was surely unnecessary at that stage since only 4 days had elapsed between the date of the first consultation and the medlab report . I am a beneficiary and although I have health insurance, the cost of a consultation would have been $300.00.
In November 2009 I was diagnosed with Haemophilus Influenzae and appropriate antibiotic treatment was prescribed. The blood test performed by Labplus on 19 November indicated a higher than usual neutrophil count of 7.84 ( norm 1.90-7.50) and monocyte count of 1.10 ( norm 0.20-1.00). The lymphocytes remain a constant 1.63 (norm 0.90-4.00) which might be considered borderline low. Frothy sputum together with large air bubbles were indicated in a photo of the haemophilus sputum. This can be indicative of a number of conditions including bronchiectasis, bronchoalveolar cancer, aspiration pneuomonitis pulmonary edema or abscess.
For the first 2 weeks of March 2011 I was again afflicted with a severe infection of the chest and sinuses with severe coughing sometimes involving a croup-like cough accompanied by purulent yellow coloured sputum. I was prescribed romicin and doxycycline
The labplus test results dated 4 and 7 March 2011 only specified “small numbers of gram positive cocci and mixed gram negative organisms-moderate numbers of gram positive cocci and moderate growth of respiratory flora”The significant sputum specimens of 2009 and 2011 appear to be similar if not identical i.e. dark yellow in colour, frothy, layered, together with large air bubbles. .
A chest x-ray undertaken by Auckland Radiology on 7 December 2010 reported “FINDINGS: The heart is normal in size and shape and the pulmonary vessels, lungs and pleura show no evidence of any pathology .IMPRESSION: Normal chest examination. ( see cardiomegaly reference below)
On 21 December 2010 I met respiratory physician Dr Stuart Jones for an early evening appointment. He checked my lungs with a stethoscope but otherwise could find nothing significantly amiss. An x-ray monitor was not available so Dr Jones resorted to holding the x-ray plates up to the light!
I pointed out to Jones what appeared to be an enlargement in the area of the heart. He made no comment. The measurement of the heart area has increased approximately 3cm from 1989 to 2010. “The cardiothoracic ratio (CTR) is the ratio of the transverse diameter of the heart to the internal diameter of the chest at its widest point just above the dome of the diaphragm as measured on a PA chest film. An increased cardiac silhouette is almost always the result of cardiomegaly, but occasionally it is due to pericardial effusion or even fat deposition.”
Jones did not check the x rays from previous years for comparative purposes. I explained that I had been experiencing pain in the left side and the centre of the chest extending around to the back causing extreme discomfort in the chest for approximately the first 20 minutes or while walking up a hill however Dr Jones ignored this complaint. The latter symptoms were having a deleterious effect on my walking capacity for some months . A spirometry test was not performed.
While he noted that “ the bronchoaveolar lavage from the right lower lobe demonstrated neutrophilia with neutrophils accounting for 72% of the cell count compared to 31% from the right lower lobe” he ignored the cell differentials for the bronchial epithelial cells in both the lobes. “On examination there was no particular abnormality. Her lung fields were resonant throughout and her breath sounds were normal with no added crepitations. Miss Wilson obviously has an abnormality with her defence leading to a recurrence of gram negative infections. It is likely that she has a degree of small airways disease and chronic bronchitis’
The BAL from the right lower lobe had demonstrated significant neutrophilia consistent with a degree of airway inflammation….I am struggling to come up with a diagnosis as to what the underlying abnormality might be …macrolides have proven to be very beneficial both for the anti inflammatory effects as well as the effect on the pseudomonas biofilm and have been shown to significantly reduce the number of gram negative infections despite the organisms not being specifically sensitive to roxithromycin and culture growth…recommend try 300mg for several months….antinflammatory medication such as non steroidal or colchicine are potential options”
He initially considered that no further investigations were necessary other than another CT of the lungs and an induced sputum. This course of action was abandoned –it was then suggested that I might consider a CT scan a “ waste of time” and as I agreed that might be the case a referral was not provided. At the end of the consultation he decided not to proceed with the the sputum test and and the form was ripped up. A thermography report dated 2003 which provided a full body scan and illustrated areas of inflammation. was disregarded by Jones. He suggested that I could perhaps see him again in 3 months. . As I departed he passed a quick aside namely “why you are kaput”!!!
I met respiratory physician Dr Christmas at Greenlane Clinical Centre on 5 October 2011. He acknowledged receipt of my email with attachments including previous chest sputum results and the latest labtest result dated 31 August 2011 indicating probable (equivocal 600H) streptococcus pyogenes infection. The physician’s report stated that “pharynx was clear and chest examination was unremarkable……she complains about some intermittent pains in the chest and sputum has shown respiratory flora and no pathogens recently” Dr Christmas briefly alluded to past “sputum samples have grown gram negative and gram positive organisms including pseudomonas aeruginosa and serratia ……but did not refer in his report to the recent streptococcus infection diagnosed in August 2011 He“ doubted that antibiotics are helpful with Vicki and I think I would avoid them as much as possible except during definite infections and not simply to eradicate organisms which you will not achieve-she appears to be quite obsessed with the organisms she has grown in the past and feels that these need to be treated and it will be difficult to convince her other wise”
I think this is also a very spurious argument if not a seriously negligent attitude particularly in respect of the recent streptococcus diagnosis which the specialist apparently chose to ignore and the long history of unusual gram negative pneumonic strains diagnosed in the last several years. It it’s a rare occasion when I am not infected.. I have suffered for about 12 months with severe inflammation in the upper part and centre of the chest together with a severe cough and simultaneous pain occasionally extending around to the back, the severity of which, on a number of occasion, has impacted on my mobility.
According to Kenneth Todars “Online textbook of bacteriology” “Streptococcus pyogenes is one of the most frequent pathogens of humans. It is estimated that between 5-15% of normal individuals harbor the bacterium, usually in the respiratory tract, without signs of disease. As normal flora, S. pyogenes can infect when defenses are compromised or when the organisms are able to penetrate the constitutive defenses. When the bacteria are introduced or transmitted to vulnerable tissues, a variety of types of suppurative infections can occur.
In the last century, infections by S. pyogenes claimed many lives especially since the organism was the most important cause of puerperal fever (sepsis after childbirth). Scarlet fever was formerly a severe complication of streptococcal infection, but now, because of antibiotic therapy, it is little more than streptococcal pharyngitis accompanied by rash. Similarly, erysipelas (a form of cellulitis accompanied by fever and systemic toxicity) is less common today. However, there has been a recent increase in variety, severity and sequelae of Streptococcus pyogenes infections, and a resurgence of severe invasive infections, prompting descriptions of “flesh eating bacteria” in the news media. A complete explanation for the decline and resurgence is not known. Today, the pathogen is of major concern because of the occasional cases of rapidly progressive disease and because of the small risk of serious sequelae in untreated infections. These diseases remain a major worldwide health concern, and effort is being directed toward clarifying the risk and mechanisms of these sequelae and identifying rheumatogenic and nephritogenic strains of streptococci.
Acute Streptococcus pyogenes infections may present as pharyngitis (strep throat), scarlet fever (rash), impetigo (infection of the superficial layers of the skin) or cellulitis (infection of the deep layers of the skin). Invasive, toxigenic infections can result in necrotizing fasciitis, myositis and streptococcal toxic shock syndrome. Patients may also develop immune-mediated post-streptococcal sequelae, such as acute rheumatic fever and acute glomerulonephritis, following acute infections caused by Streptococcus pyogenes.”
Christmas alluded to the “ mild bronchial wall thickening” reported in the CT scan of 2008 but did not refer to the two areas of minor atelectasis (collapse) in the right and left lungs nor to the bronchial epithelial cell levels specified in the bronchial lavage of 2004 (58% L and 14%R).
His report continued: “ Vicki coughs up about a half pot full of purulent looking sputum per day and she had pictures of this to demonstrate. It was brownish in colour and there was no blood -interestingly she did not cough once when she was doing the consultation-she complains about intermittent pains in the chest’ Contrary to his statement a brownish tinge can be indicative of old blood / pneumonia in the sputum.
In fact I subsequently experienced difficulties with the spirometry test conducted by an island female staff member after the consultation. Blowing into the device caused severe coughing fits including a deep seated cough on one occasion. There was no discussion on the significance of the sputum. My mother has complained about my halitosis however the physican claimed to be unaware of it.
A police car passed by with a flashing light and siren heading in the opposite direction as I was travelling to the clinic . After my consultation at Greenlane clinical centre a male police officer aged 30s of medium build short dark hair carrying a blue folder walked past me while I was seated at the bus stop. A tall female medical staff member with slightly curly grey hair and wearing a plastic identity tag around her neck appeared a few minutes later and stood a short distance from the bus stop looking on, then walked away.
A CT of the sinuses and chest ( high resolution) was performed on 14 November 2011 at Greenlane Clinic. FINDINGS: “At the right lung base there is an 8mm nodule which has a sclerotic rim with central density approximately 90 HU and peripheral density approximately 200 HU. It is not calcified. There are calcified mediastinal nodes in the anterior superior mediastinum but no enlarged nodes throughout the mediastinum or axilla. Mediastinal structures and organs below the diaphragm all appear normal. There is very minor right ower lobe bronchiectasis, without evidence of current inflammation. There is mild air trapping on the expiratory views. No pleural fluid. No bony abnormalities.
CONCLUSION: Solitary pulmonary nodule. Requires follow up and the first follow up should be in 3 months.”
A CT scan of 2008 described the nodule as “slightly lobulated and radiologically benign” .In respect of solitary pulmonary nodules Wikipedia reports: “to distinguish benign conditions from possible lung cancer. The first parameter is the size of the lesion: the smaller, the less risk for malignant cancer.Benign causes tend to have a well defined border, whereas lobulated lesions or those with an irregular margin extending into the neighbouring tissue tend to be malignant.
If there is a central cavity, then a thin wall points to a benign cause whereas a thick wall is associated with malignancy (especially 4mm or less versus 16mm or more).[4] In lung cancer, cavitation can represent central tumor necrosis (tissue death) or secondary abscess formation. If the walls of an airway are visible (air bronchogram), bronchioloalveolar carcinoma is a possibility.
An SPN often contains calcifications. Certain patterns of calcification are reassuring, such as the popcorn-like appearance of hamartoma.[1] An SPN with a density below 15 Hounsfield units on computed tomography tends to be benign, whereas malignant tumors often measure more than 20 Hounsfield units. Fatty tissue inside hamartomas will have a strongly negative value on the Hounsfield scale”
The Hounsfield unit (HU) scale is a linear transformation of the original linear attenuation coefficient measurement into one in which the radiodensity of distilled water at standard pressure and temperature”
Radiological Rounds a newsletter of Massachusetts General Hospital advises that:
“Pulmonary nodules ≤4 mm have a low risk of being cancerous; nodules between 4-8 mm are of intermediate risk for cancer; follow up CT scans for both categories are recommended on different schedules
Pulmonary nodules >8 mm and mixed solid/ground glass nodules are suspicious for cancer; percutaneous needle aspiration biopsy (PNAB), positron emission tomography (PET), or video assisted thoracic surgery (VATS) should be considered”
The expiration frame of the 2011 scan indicates a possible mosaic pattern in the lung’s lower left lobe and upon magnification a group of small irregularly shaped nodules possibly identical with popcorn shaped hamartomas? which are evident in the lower lobes of both lungs and somewhat larger in the right lower lobe. The expirational view wasn’t repeated in the 2012 scan.
According to Radio Graphics website “The “crazy-paving” pattern is a common finding at thin-section computed tomography (CT) of the lungs. It consists of scattered or diffuse ground-glass attenuation with superimposed interlobular septal thickening and intralobular lines. This finding has a variety of causes, including infectious, neoplastic, idiopathic, inhalational, and sanguineous disorders. Specific disorders that can cause the crazy-paving pattern include Pneumocystis carinii pneumonia, mucinous bronchioloalveolar carcinoma, pulmonary alveolar proteinosis, sarcoidosis, nonspecific interstitial pneumonia, organizing pneumonia, exogenous lipoid pneumonia, adult respiratory distress syndrome, and pulmonary hemorrhage syndromes”
On 27 March 2012 I met Dr Sexton at Greenlane respiratory clinic who I assumed was a registrar. He ignored the DVD containing the most recent CT scans. He did not check my throat , however , however check my chest with a stethescope including a manipulation of the upper part of the central area of the chest which is quite painful to the touch-likewise the sinuses. I am still afflicted with a “croup” –like cough. He made no comment concerning the examination. I expressed my concern about the 8mm nodule in the right lower lobe particularly the peripheral density HU of 200 and the possiblilty of malignancy however seemed to be rather dismissive of that notion did not discuss the subject in any detail and suggested that he might take the matter up with radiology.
He adopted an attitude similar to Dr Christmas in respect of antibiotics i.e. “ I advised her to work toward coming off all regular antibiotics and only using antibiotics when she has a clear cut respiratory infection – that I suspect the main driver for the presence of these organisms is her ongoing use of an inappropriate regimen of long term extremely broad spectrum antibiotics which are distorting her normal respiratory flora and causing various unusual organisms to thrive”
He agreed –that in respect of the pathogens that I have been afflicted with over the last several years one might expect evidence of more significant structural damage in the lungs however this opinion was not contained in his report. His report did refer to my having been diagnosed with “asthma /bronchiolitis and “mild right lower lobe bronchiectasis” in the most recent CT scan dated 14 November 2011
A CT ( Inspiration only) of the chest was performed at Auckland hospital on 16 May 2012. The scan merely confirmed the previous diagnosis of a “ well defined rounded 8mm nodule within the lateral basal segment of the right lower lobe is unchanged in size and morphology. No new suspicious pulmonary masses or nodules are seen . No collapse or consolidation. No interstitial infiltrate. Stable appearance of the solitary 8mm right lower lobe pulmonary nodule. It remains indeterminate in this high risk patient and further CT follow up in 6 months time is recommended .
Any reference to the previous houseman unit measurements of the 8mm nodule in the right lower lobe seemed to lacking in this particular report.
My elderly mother who had a bowel –resection in early May 2013 was diagnosed in June with staphylococcus aureus . In both our cases previous laboratory tests had specified gram positive cocci only. One might have assumed that if aureus was infecting one member of a family that cross-infection would be a possibility .
A chest HRCT was performed at Whangarei Hospital on 21 October 2014. “ Findings: Multiple bilateral axillary supraclavicular and mediastinal lymph nodes are present largest in the mediastinum with short axis diameter approximately 8mm. These are non specific and may be reactive. No pulmonary hilar lymphadenopathy is identified. Bilateral apical pulmonary fibrosis and scarring. Right posterior basal lower pulmonary lobe 8mm well defined opacity is present. No pulmonary consolidation or signs of cardiac failure . No signs of chronic interstitial lung disease. Trachea and major bronchi are patent. No bronchiectasis. No pleural effusion or calcification. No destructive bone lesions.
Conclusion: In respect of respiratory matters and a recent CT of the chest, Dr Kennedy a physician of Whangarei stated in his report dated 23 October 2014: Vicki had an HRCT scan undertaken on 21 October 2014 and I have reviewed this. There were no signs of bronchiectasis though there was minor bronchial wall thickening consistent with bronchitis. . . The oesophagus appeared unremarkable with no thickening or air fluid level and there were no signs of interstital or pleural disease ( which seems to be at variance with the HRCT report of June 2002 which specifies “ fluid is seen within the oesophagus which is a little thick walled ” There was a stable 8mm well defined non-calcified right lower pulmonary nodule with no significant mediastinal or hilar lymphadenopathy- the right lower lobe pulmonary nodule has been stable over many years and through its lack of growth has proved to be benign in nature. No radiological surveillance of the pulmonary nodule is required . “
The radiologist classified the nodule as “representing a primary benign or malignant lesion” and recommended -“ a repeat Ct scan in approximately 3 months time” His comments seems to be at variance with the comments of both Kennedy and Dr Impe of the Northland DHB who in his report dated 24 October 2014 advised “ I looked upon her previous scans from Auckland and this nodule has been present since 2011. It has remained stable in excess of 2 years (since 1999) and therefore requires no further evaluation. The radiologists had not taken note of her previous scan reports.” It would appear however that the radiologist had at least consulted the previous CT report from ADHB. It is unclear whether Dr Mpe had consulted the previous reports.
The “Bilateral apical pulmonary fibrosis and scarring” reported in this latest scan also seems to have been ignored by both physicians. Medicine net .com advises that in respect of pulmonary fibrosis : “Pulmonary fibrosis is suggested by a history of progressive (worsening over time) shortness of breath with exertion. Sometimes, during examination of the lungs with a stethoscope, the doctor can hear crackling sounds in the chest. These crackles have a very characteristic sound and are very similar to the sound heard when Velcro is pulled apart. These are often referred to as “Velcro crackles (or rales)”. The chest X-ray may or may not be abnormal. However, a special X-ray test called a high resolution CT scan will frequently demonstrate abnormalities”
A spirometry test undertaken by Dr Kennedy reported “ spirometry today showed minor restrictive picture FEV1/FVC 1.92/2.66 ( 72%) and PEFR 325L/min with predicted values of 2.46/3.18 and 370 L/min. FEV1 was 78% predicted FVC was 83% predicted.”.
Some large horse shoe shaped cells appear to be evident ( but not reported) in an expiratory sequence of the right lung CT scan of 21 October 2014. Wikepedia advises that “they are formed by the fusion of epithelioid cells (macrophages), and contain nuclei arranged in a horseshoe-shaped pattern in the cell periphery and are probably identical with Langhans cells. Although traditionally their presence was associated with tuberculosis, they are not specific for tuberculosis or even for mycobacterial disease. In fact, they are found in nearly every form of granulomatous disease, regardless of etiology. Clinical significance: Langhans cells are often found in transbronchial lung biopsies or lymph node biopsies in patients suffering from sarcoidosis.”[5]
The American Lung Association states: In sarcoidosis, immune system cells that cause inflammation overreact and cluster together to form tiny lumps called granulomas. If too many of these granulomas form in one organ, it may not be able to work correctly. For example, if the granulomas damage healthy tissue in the lungs, scarring and stiffness may occur and limit how much air the lungs can hold. This condition is known as pulmonary fibrosis. The problems caused by sarcoidosis differ depending on which organ is affected.
According to Medicine.net.com: Blood tests can measure a blood substance called angiotensin converting enzyme (ACE). Because the cells that make up granulomas secrete large amounts of ACE, the enzyme levels are often high in patients with sarcoidosis. ACE levels, however, are not always high in sarcoidosis patients, and increased ACE levels can also occur in other illnesses
In the early 1980’s I was afflicted with a probable case of erythema nodosum on the calves of both legs. “Erythema nodosum may occur as an isolated condition or in association with other conditions. Conditions that are associated with erythema nodosum include medications (sulfa-related drugs, birth control pills, and estrogens), strep throat, Cat scratch disease, fungal diseases, infectious mononucleosis, sarcoidosis, Behcet’s disease, inflammatory bowel diseases (Crohn’s disease and ulcerative colitis), and normal pregnancy.
Erythema nodosum (also called EN) results in reddish, painful, tender lumps most commonly located in the front of the legs below the knees. The tender lumps, or nodules, of erythema nodosum range in size from one to five centimeters. The nodular swelling is caused by a inflammation in the fatty layer of skin
In addition I was also affected by erythema palmar a distinctive dark reddish discolouration at the edge of the hands which is still evident today Website Patient UK states: Secondary palmar erythema can be attributed to:
Liver cirrhosis and its many causes including alcohol abuse.[4](Palmar erythema develops as a result of abnormal oestradiol levels.)[1]
Hereditary liver disease such as Wilson’s disease and hereditary haemochromatosis.[1/////]Rheumatoid arthritis (associated with a favourable prognosis).[////// /systemic-lupus-erythematosus-pro”Systemic lupus erythematosus.5Thyrotoxicosis.]Diabetes mellitus.[/////Sarcoidosis./////[7Gestational syphilis.///[1]Human T-lymphotropic virus type 1 (HTLV-1)-associated myelopathy.///] Neoplastic disease (as a paraneoplastic disorder), particularly primary or metastatic brain neoplasms.[1][9]However, also associated with ovarian carcinoma.[///////]Drug-induced (amiodarone, gemfibrozil, cholestyramine, topiramate and salbutamol have all been implicated).[////1][11] Chronic mercury poisoning//// Polycythaemia
Kennedy further reported : “Spirometry shows no features or airflow limitation. Vicki had mild asthma and bronchitis during childhood though seemed to grow out of this. Tirals of inhaled corticostseroid were unhelpful”. ( My asthma was quite severe requiring the use of an inhaler in the 1960s and occasionally in recent years) Vicki has been bothered by troublesome cough and recurring epsodes of bronchitis and sinus infection….a variety of organisms grown from sputum. She is a distant ex smoker having smoked an average a packet of of cigarettes a day for over a 30 year period ceasing in 1992″ Most of the organisms are gram negative pathogens and in 2003 I was infected with a severe case of probable bronchial pneumonia to the extent that my general practitioner Dr Holton had suggested that I might be hospitalised.
There are recurring episodes of bronchitis with multiple different organisms having been cultured in the past ….I would recommend sputum clearance techniques and I have referred Vicki through to the physiotherapy department under whangari hospital for help with this. …One option for patients with recurring infective episodes in COPD and bronciectasis is a prolonged ( 6-12 ) months course of Azithromycin three times a week.-she tell me that a variety of organisms have been grown from sputum ..there has been some question as to whether some of these organisms have been oral bacteria that have contaminated sputum cultures”
This appears to be a somewhat irrelevant concern as the Laboratory frequently specifies “Heavy growth of pseudomonas species” with a recommended drug treatment. I frequently experience quite severe pain in the centre and lower part of the chest and occasionally the thoracic spine dependent on the severity of the infection. I did advise Dr Kennedy in our consultation however he doesn’t appear to have referred to it in his report.
While a suspicion of minor right lower lobe bronchiectasis was reported on an HRCT of 2011 this has been excluded in the latest scans. “There was minor generalised lymphadenopathy not reaching levels of significance One option for patients with recurring infective episodes in COPD and bronchiectasis is a prolonged ( 6-12 ) months course of Azithromycin three times a week”. Pseudomonas Aeruginosa is resistant to Azithromycin.
A number of irregularly and spherical shaped cells in the lower lobes of the right and left lungs which do not appear to have been reported Despite the stability of the nodule it does have characteristics namely that is non calcified, has a sclerotic rim and extremely high central and peripheral densities as reported in 2011 which were not referred to by either respiratory physician.
A test for serum IgE ( allergy) of 7 November 2014 was 23 kIU/L ( norm: <100)////////3/4/2023 9 kIU/L Very Health advises Low IgE Low serum IgE is associated with:Chronic fatigue////Asthma/////A higher likelihood of autoimmune and oncological diseases///Chronic sinusitis, or inflamed sinuses///Otitis media, or fluid in the ear I visited Dr Kennedy at Whangarei Hospital at the Respiratory Outpatients clinic on 13 March 2015. . His report dated 16 March stated “ Ciprofloxacin 500 mg –about to cease -I have not recommended a further course of antibiotics at this time. I suggested that after 10-20 years the more appropriate concern might be treatment and containment of the pathogen . I explained that I experience pains in the lungs from time to time depending on the severity of the infection and I also have a heart condition. He referred to the “ occasional and long standing bibasal pleuritic type chest pains though this is not a prominent feature” (Gram negative infections can precipitate heart attacks.) During the consultation Kennedy claimed that the scarring and fibrosis evident in the latest scan was only minimal –however he did not refer to same in his report. My query that sarcoidosis might also be a possible diagnosis resulted in no response from Kennedy. I referred to the notations in the CT report of 2011 concerning the high houseman unit readings – and the characteristics of the nodule in the base of the right namely that it was sclerotic and non calcified. He suggested that some benign nodules were non calcified and vice versa.! As there had been no change in the size of the nodule in over 2 years then “no further CT surveillance was required”. He disregarded the radiologist’s recommendation of October 2014 for a follow-up CT scan in three months and his assessment that the nodule might be either “ malignant or benign”. Kennedy claimed “that the radiologist who reported the most recent CT chest did not have the luxury of access to the earlier scans”! This seems to a rather odd if not evasive statement –one would assume that it would be almost mandatory for physicians and radiologists to gaining access to the details of previous CT scans and reports. Kennedy advised that there would be further CT scans. An ECG was performed which indicated “ a possible inferior infarct- abnormal ECG” . This was not discussed during the consultation however Kennedy did refer to it in his report “ A resting 12- lead ECG today showed sinus rhythm 70/min normal QRS axi, small Q waves in the inferior leads , not reaching levels of significance no left ventricular hypertrophy or strain minor T wave flattening in the anterosepetal leads.” “A chronically occluded left circumflex” which was also referred in the report is still outstanding from an initial diagnosis in 2003. “ Spirometry today showed sub-optimal technique with a poor start which will have influenced the FEV, value with FEV1/FVC 1.76/2/2.61 (67%) with predicted values of 2.21/2.64 . FEV 1 was 80% of predicted ( though likely under-estimated ) and FVC was 99% of predicted.” I was not advised that anything was amiss with the spirometry testing by the presiding nursing staff . A spirometry test performed by Dr Wilsher in 2009 reported “Her spirometric lung volumes are normal with an FEV 1/FVC of 2.34 /2.72. In respect of my enquiry concerning missing set of images from a CT lung scan of October 2014 I received the following reply from Tracey Hildreth Release of Information Officer Northland District Health Board on 18 March 2015: “ I have discussed with our PACS office (Picture Archiving and Communication System) in our Radiology dept. It is normal that there will be Reports and Images missing. In your case it being No.6. This is due to when a series of Images are taken there will always be certain ones that do not require reporting on, in your case No.6 did not require to be reported on and thus is why it is missing.” This was confirmed by radiology staff in a phone conversation on 23 March 2015. I subsequently emailed a complaint to Mr Potts the general Manager of Clinical Services about my nodular concerns. His reply dated 12 October 2015 : “ I write to provide an update on my investigation of your concerns regarding your follow-up. Following discussion with Dr Kennedy and Dr Mpe, we have agreed to seek the opinion of a tertiary specialist radiologist regarding what the most appropriate follow-up would be in the light of your scan images. I will reply formally to your complaint when we have obtained this opinion. Kind regards. Andrew Potts General Manager Clinical Services As a result of Mr Potts initiative I received a copy of a reply from senior radiologist Dr David Milne of AD HB. In his letter dated 14 October 2015 he stated that “ I have reviewed the CT imaging from 7/1/2008 performed at ascot Radiology and from Northern Radiology from 21/10/2014. There is a solid 8mm lobulated nodule in the lateral basal segment of the right lower lobe. This has no calcification or fat with in it and has no particular distinguishing features. ( Dr Milne seemed to be unaware of the characteristics of the nodule detailed in the CT report of 2011 and specified in my letter to Mr Potts Clinical Director of Northland DHB) ) Our experience of having biopsied thousands of lung lesions over 20 years is that the yield from biopsy of nodules this size is less than 50% positive diagnosis. The current CT imaging from Northern Radiology was clearly reported without knowledge of the prior scans and has been considered as a new finding with further surveillance imaging recommended. If this was indeed a new finding then in 2014 CT PET could also be considered in the management of this nodule along with surveillance scanning…..the nodule is clearly not new and is entirely unchanged between the scans of 2008 and 2014. the stability satisfies all current criteria for the nodule being benign and further follow up of this nodule is not required. We can be certain that this nodule is benign. There is no bronchieactasis and the mediastinal adenopathy demonstrated is normal and no abnormal nodes are seen on the most recent CT imaging. No follow up imaging of any type is recommended based on the findings of the CT examination of 21 October 2014.” The longevity of the nodule would seem to be an irrelevant consideration in view of its specified possibly malignant characteristics. As the latter might be suggestive of malignancy one might have considered it prudent to have instigated further investigation such as fine needle aspiration. I have a 20 year history of smoking , am now permanently afflicted with Pseudomonas Aeruginosa and frequntly afflicted with pain in the lower lobes and a have a regular cough. I would not have thought it appropriate to have curtailed regular CT scanning. There seems to be a difference in medical standards between New Zealand and their overseas counterparts. Sputum tests performed by Northland DHB( Labtests Auckland) on 26 February 2015 and 3 June 2015 reported “ large number of gram negative bacilli moderate numbers of gram positive cocci Culture: Heavy Growth of Pseudomonas species” and an identical subsequent diagnosis with “occasional polymorphs present” Ciprofloxacillin was prescribed in February and August 2015. Pseudomonas continued to be diagnosed by Northland pathology on 6 September and 16 December 2015 Only a limited supply of Ciprofloxacin was prescribed in December 2015. ( see general practitioners) . The pathology test dated 23 February 2016 reported “moderate number of polymorphs , small numbers of epithelial cells, large numbers of Gram negative bacilli, moderate numbers of gram positive cocci: Culture: heavy growth of Pseudomonas species. A prescription for 10 days of Cipro (1,000 mg per day) was provided in early March 2016. On 14 October 2016 Northland Pathology reported a “ heavy growth of Pseudomonas species “ evident in a chest sputum sample. AFB (TB) tests have been undertaken at Medlab on 21 June 2002, Labtests on 9 October 2009, and Labtests on 31 December 2014. All tests reported “ no mycobacteria species isolated after six weeks”. A consultation was arranged with Dr Megan Cornere on 18 April 2016. Dr Cornere is Director of respiratory Services at Waitemata DHB. I had emailed Cornere a number of relevant images and reports. She did refer to them briefly but they were not otherwise discussed at length.. They clearly showed the lung nodule in the right lobe and what appeared to be another smaller nodule in the left lobe. While Cornere referred to my having been previously afflicted with erythema nodosum in the early 1980’s she omitted any reference to the simultaneous diagnosis of erythema palmar an image of which was shown to her in the consultation. Dr Cornere advised “ It remains likely that Vicki has an underlying small airways inflammatory disorder with very little to see on high resolution CT scanning and excessive sputum production. She has recurrent Pseudomonas and the question remains as to whether or not this has colonised her lungs. Despite my attempt at reassurance she remains worried that the right lower lobe nodule could be cancerous and was questioning whether or not a CT PET would be appropriate. In the first instance I think it would be appropriate to repeat a high resolution CT scan of her lungs to see if there has been any development of bronchitis/bronchiectasis or small airways inflammatory disease. She will also have a CT scan of her sinuses to ensure that significant sinusitis is not contributing to her symptoms. If pseudomonas remains a concern we could consider 3 months treatment with nebulised aminoglycosides as she has had multiple courses of ciprofloxacin in the past. As the nodule remains an ongoing concern despite reassurance we could pose the question as to whether or not the nodule would be amenable to FNA. Although it is sub-centimetre a skilled radiologist may be able to perform this which would at least put paid to her concerns as to its malignant potential. I suspect this would be a difficult procedure with low yield. As such I have referred her to Green Lane imaging as they have significant expertise. I do not think at this point that a CT PET would be appropriate and I have explained my rationale to Vicki.” I consulted Dr Cornere as a private patient. I did not attend at Green Lane imaging. I had expressed my concern over the status of the lung nodule in the right lower lobe and the cancelling of t he CT scans by Dr Kennedy. Dr Cornere was not prepared to discuss the significance of the characteristics( high houseman unit readings) of the nodule specified in an ADHB report of 2011 which might be suggestive of malignancy. Dr Cornere reiterated the statements of Kennedy and radiologist David Milne that the sole criterion conerning a slow growing nodule of 8mm was that it had remained unchanged in size for 2 years. I had complained about the inflammation in the centre of the chest and the pains in the lower lungs the dependent upon the severity of the infection. The discomfort was often sufficiently debilitating to make walking difficult . “ Bilateral apical pulmonary fibrosis and scarring “ together wi th “ multiple bilateral lymph nodes described as non-specific and possibly reactive” were reported by Northland DHB in 2014 but again were not alluded to by the Cornere. I had advised her of a previous consultation with neurologist David McCauley and my dissatisfaction that he had apparently ignored the subsequent MRI brain scan report of October 2015. Gyral or serpentine leptomeningeal enhancement and thickening of the meninges were clearly evident in the MRI scan of 2015 but were not diagnosed and the report apparently ignored by Dr McAuley. An erroneous assessment was also made by neurologist Dr Charleston who claimed to have consulted neuroradiologists at Auckland Hospital. I had also provided Cornere with a copy of an image clearly depicting leptomeningeal enhancement however she did not consider that it was a matter for her to deal with despite my advice that the first bout of probable meningitis occurred in the late 1980s’s in conjunction with a severe sinus and chest infection. Nevertheless Cornere incorrectly stated “ that Vicki was seen by David McCauley last year and continues to remain concerned that the MRI and CT images demonstrate evidence to support chronic meningitis despite his reaassurance that this is not the case”. A CT Chest and Upper Abdomen( high resolution of the chest without intravenous contrast) was performed at Whangarei Radiology on 27 October 2016. Findings: “ Right lower lobe lobulated well-defined soft tissue density 8m nodule is better defined on today’s CT scan and then on the previous CT scan but does not appear to have changed in size or shape since the previous CT scan. Anterior and lateral right upper lobe 3 mm well- defined nodule is also present and restrospect and is unchanged. Bilteral apical fibrosis is unchanged. Trachea and major bronchi are patent and there is no bronchiectasis . No pleural effusion. Numerous small axillary and mediastinal lymph nodes are unchanged. No pulmonary hilar lymphadenopathy. No abnormality is identified on these unenhanced images of the upper abdominal viscera that are included within the field of view of this examination. There is a hiatus hernia. No destructive bone lesion. Conclusion: right lower lobe 8mm and right upper lobe 3 mm nodules are unchanged. Suggest follow-up CT scan in 6 months. Lymph nodes are unchanged”. Once again the clearly defined characteristics of this 8mm nodule specified in an ADHB Radiology report of 2011 have not been referred to. With regard to laboratory tests, although microscopy details are sometimes the same ( large numbers of gram negative bacilli which are the equivalent of a heavy growth of pseudomonas ) a culture is not always specified and as a consequence the general practioners won’t prescribe ciprofloxacillin. That seems to be rather remiss in respect of a chronic long term sufferer with a heart condtion. I also experience pain in the centre of the chest and lower lobes which at times can make walking very difficult As a consequence I have had no ciprofloxacillin prescribed from September 2017 until February 2018. I did email my concern to Labtests however I was advised that the matter would need to be referred by a general practitioner. Dr Sprague seemed somewhat reluctant to pursue a further enquiry. A mammogram was performed at Mauri Ora mammography on 17 January 2017. In one frame a small bright line extends under the breast . When it is magnified a dense cotton wool type of infiltrate/opacities are depicted in the chest wall possibly extending into the breast. An email requesting further advice and with accompanying images was sent to Breast surgeon Dr Shan on 8 June 2017 but there was no reply from either Shan Emails were also sent to Dr Cornere director of the Waitemata Respiratory and Dr Dawber NDHB radiologist. In her email dated 22 June 2017 my general practitioner Dr Henderson stated: “Hi Vicki Thank you for the films. I am not a radiologist but from my training I cannot see any features on your imaging that would raise alarm bells for me. The patchy changes in your screen shot are normal findings on many x-rays – particularly when looking through dense tissue due to the variable uptake of the x-ray radiation. Dr Kim Shepherd is a very skilled radiologist who reads the vast majority of breast imaging and I have faith that she would have reported any changes of concern. Regards Dr Henderson” On 8 June 2017 NDHB radiologist Dr Dawber advised : I am unable to comment on the Mercy Radiology MRI and the Mauri Ora Breast Screen mammogram and would advise you to contact them if you require any further information about these two studies. With regards the CT Scan of 2014 I am not sure what “horseshoe shaped cells” you are referring to, but individual cells are too small to appreciate on CT Scan. The somewhat “horseshoe shaped” structures in the lungs on the image that you have included with your email are lung blood vessels a little blurred by movement from breathing. In her emailed reply dated 3 July 2017 Dr Cornere stated: “Dear Vicki I am sorry I can’t be more helpful but I have absolutely no experience in interpreting mammography.Hopefully you will get a reply from the radiologist and breast physician who should be able to assist as they have the expertise Kind regards Megan Cornere” A chest x ray was performed at whangarei hospital on 8 January 2018. Radiologist Jan Walsh reported “ Nodular density evident at the right base with further lesion in the right upper pole and possibly also the left base. I note the patient is under care of the chest team. The lungs otherwise appear clear. Normal heart size, mediastinal outline and hila”. ( the possible presence of a nodule also in the left base has not been referred to previously) On 14 February 2018 a reply was received at the Onerahi Medical practice from Dr Tan a respiratory physician in response to a request from Dr Detjen of Onerahi Medical “I see her CT scan in 2016 being quite normal and devoid of bronchiectasis. I make note of her previous review with Mark Kennedy . I suggest she has a chronic cough previous smoker with a normal CT. I would agree with you that regular antibiotics is not required in this patient in this particular case. She is not even growing pseudomonas species. Consider changing the ACE-1 to an ARB in case this is an ACE induced cough. Approach to her chronic cough as outlined in the cough pathway-routine spirometry +/- trial of ICS.” (See also general practitioners) This seems to be a somewhat erroneous assessment by both Dr Detjen and Dr Tan- I have a long history of gram negative chest infections, scarring and fibrosis in the lungs and a nodule which is possibly malignant. Any coughing is related to my chronic long term chest infections and is not ACE induced. Dr Detjen should have been able to access my previous laboratory reports -her actions might be construed as obstructive in respect of obtaining appropriate medical treatment. On 22 February 2018 I onforwarded an email to Dr Roberts Chief Medical officer of Health for Whangarei expressing my concerns about respiratory, manmography neurology matters including a local general practitioner. In his reply dated 22 March Dr Roberts advised “I did not reply to your earlier mail because there did not appear to be a question for me to address. It seemed simply to pass on a considerable amount of information about your past medical care . Having reread that email today I remain unclear of your reason for contacting me. I would be most grateful for your advice in this regard.” My reply dated 2 April 2018 stated “I would have thought it obvious that the general nature of my email was that of a complaint which was sent to you in the hope you might be able to rectify some of these issues.” My complaint was also onforwarded to NDHB CEO Dr Chamberlain on 13 April 2018 and was in turn onforwarded to Quality and Control and finally the General Manager, Medicine, Health of Older People, Emergency and Clinical Support Mr Beney. On 30 April he advised “ due to the number of services involved it is taking time to get the required information to respond to your concerns”! In June 2018 a response was received from Respiratory Physician Christine Bradley: “ Thank you for this referral. This lady has been seen recurrently in Auckland and here. Her right lower lobe nodule has been unchanged since 1999 her last CT was in 2017 so there have been 18 years of stability and t his does not require a repeat CT at any point. Her prior breathing tests indicated mild obstructive disease likely secondary to a 30 pack year smoking although remote. She has intermittently grow Pseudomonas species Haemophilus influenzae, Serratia (2003,2005 and 2007) Stenotrophomonas maltophilia ( 2006), Ongoing antibiotics lead to development of resistance species so they would only be indicated when true infection is indicated-marked increase in sputum with colour change plus or minus fever. My initial approach would be to treat as any bronchitis using augmentin , Roxi or doxy .would stop culturing unless she was clearly not responding. She has declined three day weekly azithro in the past. Her last CT does not show bronchiectasis . I do think she is likely a very challenging patient but I am not sure how I can add further to my colleagues over the years. Thanks Christine My emails, which contained respiratory images, including the dense opacities evident in a mammography frame, were sent to to Dr Bradley on 28 September 2018 and to Dr Mpe Senior Respiratory Physician NDHB on 31 July 2018. I had requested a re-consideration of the decision not to continue with CT chest scan however there was no response. A reply was eventually received from Mr Beney dated 28 October 2018. He referred to “ your email and attachments which were received by Dr Bradley on 18 September 2018-as you raised a concern that was outside of her area Dr Bradley forwarded your email on so a coordinated approach to your response could be provided. Dr Bradley the declined request for a clinic review and reinforces that there is no evidence for bronchiectasis. The nodule has been under surveillance for well beyond the recommended timeframe. She does not believe there is a reason for a review in the respiratory clinic.” In respect of mammography(respiratory) “ On receiving your concern Dr Kim Shepherd requested Dr Walker ( Clinical Director for Breast Screening Waitemata-Northland) review the images and she agrees with Dr Shepherd’s email to you on 19 June 2017- I have looked at this mammogram with my colleague Dr Wild. The appearance you have shown on your first magnified image is normal skin and subcutaneous tissue. I would like to reassure you that I can see no areas of concern on your mammogram” . This would seem to be an erroneous assessment pertaining to the original frame not the magnification. I attended ED at North Shore Hospital on 6 May as I was afflicted with a chest infection. I was attended by Dr Etienne De Beer .( Senior Medical Officer)> “ History of presenting complaint: cough productive of yellow tinged sputum x 1 week. Sore throat now resolved and coryza ( inflammation of nasal mucous membranes) headache and sinus pains. No fever. No dyspnoea- Primary diagnosis : RESLRTI LRTI unspecified -includes bronchitis- the trachea was central and the lungs clear. Initial impression/Assessment Acute LRTI . “ RR : 16 bpm////02Sat 98%/////Fi02: 21%( oxygen flow rate)///////// General exam: alert and appears well. Colour, hydration, perfusion normal. No oedema. CXR normal. Public Health subsequently advised by text that the result of the nasal swab for COVID 19 was “negative” Dr De Beer provided a prescription for a repeat of most of my usual medications ( not including omeprazole) and a 2 weeks supply of ciprofloxacin normally previously prescribed for pseudomonas aeruginosa. A covid 19 test from a nasopharyngeal swab was negative,
A mobile chest x ray report: cardiac and mediastinal contours normal. The lungs and pleural spaces are clear. ( Richard Beedie Radiologist), Dr De Beer also assessed the lung scan as ne Waitemata Respiratory Clinic on 17 July 2020. Nursing staff assessed my height and weight but did not check my blood pressure. I discussed the x ray dated 6 May 2020 which contained evidence of previously diagnosed lung nodulesin the base of the right lower lobe and a previously undiagnosed but probable somewhat obscured nodule/mass evident in the left lower lobe While nodularity in both lower lobes was evident in the latest x ray it was not diagnosed .The latest x ray was not available fo r viewing in the consultation however Dr Cornere did take note of those nodular details. Dr Cornere referred me for another CT lung scan which is scheduled for early August. I asked for her opinion about the frame indicating dense opacities which seemed to involve the chest wall and the breast extracted from a mammogram dated 2017 . The frame was disregarded by Dr Cornere. She provided a stethoscope chest check , a referral for blood and sputum tests, and a prescription for roxithromycin. We had discussed nasal saline sprays however Dr Cornere prescribed teroclear nasal spray to be used in conjunction with saline douche. A medical recommendation is generally required in respect of a steroid spray particularly if a nasal or sinus infection is present.
Dr Corneres report dated 16 July 2020 is as follows:
: Problem Chronic productive cough with recurrent respiratory tract infections and history of recurrent bronchitis and Pseudomonas colonisation.
Bronchitis since childhood, with associated asthma. Longstanding issues with bronchitis since the 1970s -20- to 30-pack-year smoking history, having stopped in 1992. Previous hypertonic saline challenge negative-.BAL 2004 72% neutrophils- HRCTs at multiple sites dating back to 1999. CT chest 27 October 2016 documenting right lower lobe 8 mm nodule, right upper lobe 3 mm nodules are unchanged- Bilateral apical fibrosis is unchanged.- Trachea and major bronchi are patent and there is no bronchiectasis- numerous small axillary and mediastinal lymph nodes are unchanged. No pulmonary hilar lymphadenopathy .CF mutations negative. Variable response to macrolide therapy in the past. No significant improvement in symptoms with inhaled corticosteroid. History of erythema nodosum but no suggestion of sarcoidosis on HRCT.
Multiple sputum cultures since 2003 including Haemophilus, Staph aureus, Serratia,Stenotrophomonas, Pseudomonas aeruginosa to name a few (Vicki has an extensive and comprehensive list of all pathogens cultured Aspergillus serology negative 2014. Low-level IgA 0.7 in 2009, 0.6 2014 – no known immunology review. 1990s Letters documenting normal lung function Clinic spirometry April 2016 FEV1 1.79 (77%).
Previous respiratory physicians seen to date include Adrian Harrison 1995, Jeff Garret April/May 2002 and July 2004, John Kolbe in May 2004, Margaret Wilsher in 2009, Stuart Jones in December 2010, Tim Christmas 2011, Paul Sexton March and June 2012, Mark Kennedy October 2014, myself April 2016 History of TB contact with father suffering from TB. (It is uncertain as to whether my father was ever afflicted with TB as opposed to his father who was seriously ill with TB No AFBs cultured in the past. Multiple cultures of Pseudomonas in the last 18 months, treated with ciprofloxacin.
A full blood count 7 May 2020 -normal, lymphocytes reduced at 0.7. COVID negative. Chest x-ray 7 May 2020 cardiac and mediastinal contours are normal. Lungs and pleural spaces are clear Right lower lobe pulmonary nodule present since 1992 CT scans x 2 in 1999, 7 May 2008, 14 November 2011, 16 May 2012, 21 October 2014 and 2016 all demonstrating stability of the nodule. Family history of lung cancer .
Rhinosinusitis. CT in 2014 documenting no significant sinusitis . Escalation in sinus congestion, obstruction and headache. History of dyslipida .Hyperthyroidism, on long-term carbimazole . Previous gastric ulcer related to nonsteroidals with haematemesis requiring transfusion. lschaemic heart disease – Coronary angiogram 26 November 2013 severe stenosis distal LAD with further DES, severe ostial PDA disease, chronically occluded left circumflex ..Last reviewed by Cardiology :Northland August 2018
History of chronic fatigue and fibromyalgia. Systemic. hypertension with episodes of hypotension, presyncope and generalised bilateral visual abnormality in December 2013. CT MRI performed reviewed by David McAuley in 2015. Concern regarding chronic meningitis, thrombosis and connection to Pseudomonas colonisation seen by Alison Charleston May 2016 ? result.
Medications: Aspirin 100 mg daily. Salbutamol 200 mcg inhaled prn. GTN spray as direct .Cilazapril Plus 1 tablet daily. Atorvastatin 40 mg daily Omeprazole 40 mg daily. Carbimazole 5 mg daily. Roxithromycin 150 mg orally bd for six weeks.
Therapy as above: HRCT chest and CT sinuses Repeat full blood count. Sputum for culture if necessary, Baseline lung function including FeNO. Outpaiient Clinic Repeat blood count CRP and immunoglobulins.
It was a pleasure to review Vicki in clinic. I have not seen her since 2016. In this time she has continued to have a chronic productive cough with recurrent respiratory tract infections. She has had multiple courses of ciprofloxacin for sensitive Pseudomonas. When I saw her in 2016 our thoughts had been that this was a colonisation as opposed to pathogenic—?however, Vicki does report feeing unwell with these infections. Vicki also describes discomfort in her chest and feels fatigued. She also experiences sino-nasal symptoms which have escalated and she now has obstructive and congestive symptoms with associated headache. She does take her salbutamol inhaler, which she uses occasionally when required. Vicky continues to cough the purulent-appearing sputum and has recently finished a course of ciprofloxacin.
Vicki last had a CT scan in 2016 which demonstrated the right lower lobe nodule, upper zone fibrosis and no other findings of concern. This has been summarised as above.Vicki’s past medical history is extensive and again I have endeavoured to summarise the pertinent points of her history above.
Examination:
On examination today, she looked well. She was not breathless at rest. There is no digital clubbing or cervical lymphadenopathy. Heart rate was 80 per minute and regular. Heart sounds dual, chest clear to auscultation.
Comment:
In summary, Vicki is known to have recurrent respiratory tract infections. interestingly she has had a low serum IgA, which may predispose her to recurrent respiratory tract infections. To my knowledge she has not had a previous immunology review. She has had a variable response to macrolide in the past but I think in view of ongoing congestion this should be considered. She has a sputum pot for culture should her sputum change in colour and given that she now has more in the way of sinus symptoms, the above therapy. She will have a repeat CT scan of her chest and sinuses to exclude significant sinusitis and also to review the recurrent infection to ensure that she has not developed significant bronchiectasis in the interim.This will also review the lower lobe pulmonary nodule which has been present since 1999 and also the upper lobe fibrosis which was concerning also to Vicki.
Vicki will have the above blood tests for completeness and to recheck her immunoglobulins and ensure the mild lymphopaenia has resolved. She will also have baseline lung function as we may consider optimising inhaled therapy if this is what Vicki wishes.
Moving forward one consideration in view of the recurrent Pseudomonas would be nebulised gentamicin. I will, however review Vicki with the results of her investigations and formulate a management plan accordingly.
Addendum: Blood work: Normal immunoglobulins, FBC, CRP
Dr Megan Cornere MBChB, FRACP, PhD Respiratory Physician
A few extracts from Dr Cornere’s report are detailed below”
a) “history of recurrent bronchitis and Pseudomonas colonisation-when I saw her in 2016 our thoughts were colonisation as opposed to pathogenic” . I never agreed to an assessment of colonisation as I have been afflicted with serious chest and sinus infections extending back to the 1970s.
(b) “BAL 2004 72% neutrophils” – The Bronchoalveolar lavage also reported twice the number of bronchial epithelial cells in the left lobe (58%) as opposed to the right. (14%)
© “Chest CT 27 October 2016 documenting right lower 8mm nodule”……. The CT report dated 14 November 2011 reported “ at the right lung base there is an 8mm nodule which has a sclerotic rim with central density 90HU and peripheral density 200 HU. There is very minor right lower lobe bronchiectasis-there is mild air trapping on the expiratory views”
(d) “Numerous small axillary and mediastinal lymph nodes” The ADHB report dated 21 October 2014 referred to the lymph nodes as “ non specific and may be reactive”
(e ) “ No significant improvement in symptoms with inhaled corticosteroid” I have found the steroid inhaler very helpful in respect of inflammation.
(f) History of erythema of nodosum but no suggestion of sarcoidosis in HRCT: Erythema palmar occurred simultaneousely with erythema nodosum in the early 1980s.
(g) “Coronary angiogram 26 November 2013 …..distal LAD with further Des severe ostial PDA disease chronically occluded left circumflex” Stenting of the left main and left descending arteries occurred on 15 November 2011.
(h) “CT MRI (brain) performed -reviewed by David McAuley in 2015……….seen by Alison Charleston May 2016? Result.” There was no further communication from Dr Mcauley subsequent to the first consultation nor was there any assistance from Dr Charleston. There were some unsatisfactory aspects concerning non-reporting in the scan.
CT HRCT Vicki Wilson NHI GRD 8664 5 August 2020
Clinical: recurrent infections with multiple pathogens including pseudomonas. Continues to expectorate purulent sputum . Sinusitis nonsmoker. Hx of 8mm nodule RLL previously under surveillance and upper lobe scarring and fibrosis. Question: ? bronchiectasis ? atypical infection?other? interval change in pulmonary nodule. Comparison made with prior HRCT latest dated October 2014.
The 8mm nodule in the lateral basal segment of the right lower lobe is stable unchanged compared with prior examinations back to 2012. No other lung nodule is seen. There is no bronchiectasis,emphysema, interstitial lung disease or evidence of small airways disease. There is stable minor scarring in the inferior division of the lingula segment of the upper left lobe. Trivial apical pleural thickening noted bilaterally with no evidence of underlying adjacent pulmonary parenchymal scarring. No hilar or mediastinal lymphadenopathy and no pericardial or pleural effusion. There is a small sliding hiatal hernia approximate 5 cm height.
John Gunn Radiologist North Shore Radiology
Website Radiopaedia advises that “Apical pleural thickening: Thickening of the top-most portion of the pleura. This type is benign unless the pleura has thickened more than two centimeters. Focal pleural thickening: Thickening confined to one or more specific areas of the pleura. Pleural thickening can be serious, especially when it reaches more advanced stages. The presence of pleural thickening is not enough to confirm a pleural mesothelioma diagnosis, but it can be a sign of serious and significant asbestos exposure. . Healthtop questions advises: “There are many causes for apical pleural thickening, including: bacterial pneumonia; chemotherapy; infection; lupus (an important factor because it can cause infl body” The CT report of October 2016 stated: Bilteral apical fibrosis is unchanged”
Consultation with Dr Chapman on 4 November 2020:
Dr Chapman was also probably unaware?of the details of ADHB reports of 1999 and 2002 which specified “several lymph nodes lying adjacent to the the main trachea -no pathological lymphadenopathy” or the report of 2002 –“ very minor atelectasis in the right medial aspect of the middle lobe and the lingular segment of the left upper lobe”. Chapman did refer to the “BAL of 2004- 72% neutrophils” but not the reference to “twice the number of bronchial epithelial cells in the left lobe as opposed to the right” As with Dr Cornere’s report there was no mention of the characteristics associated with the 8mm lung specified in a 2011. What appears to be a small nodule in the left lower lobe was also evident in the 2014 scan but not reported.
CT report of October 2014 states “Conclusion: Well defined 8mm opacity in the posterior basal segment of the right lower pulmonary lobe is non-specific and may represent a primary benign or malignant lesion and CT scan surveillance of this is advised with repeat CT scan in approximately 3 months time. Non-specific axillary, supraclavicular and mediastinal lymph nodes possibly reactive . No bronchiectasis. Chapman described the recent CT sinus scan of 5 August 2020 as showing “minimal nasal disease”. I am however almost permanently afflicted with sinus infections.
Chapman commented “ she does not have faith that recent sputum cultures particularly looked for relevant pseudomonal infection and that the mixed gram negative organisms which were commented on she feels is her culprit infection of pseudomonas. Currently she complains of having a croaky voice and coughing up dark yellow coloured phlegm -she does not particularly report breathlessness or wheeze but was very focused on the fact that she required antibiotics particularly ciprofloxacillin. Conversely cardiologist Dr Glenie later reported “She has occasional crepitation at the left base but otherwise the chest was clear”
We have not seen any pseudomonas on sputum culture for over a year now despite multiple testing and the CT scan does not show any bronchiectasis. I did not think antipseudomonal antibiotics were indicated but that we should consider that if we found pseudomonas going forward. I am usually in favour of treating pseudomonal infection aggressively with intraavenous antibiotics and possibly nebulised gentamicin in my bronchiectatic patients. It is interesting to me why she has cultured such an array of bacterial pathogens which we would normally see in a cases of bronchiectasis yet she had no development of bronchiectasis over the years” “Minor right lower lobe bronchiectasis and mild air trapping in the expiratory view” was reported in a NDHB report of 2016.
I explained to Dr Chapman that I have a long history of chest infections extending back to the 1970s -diagnosed as primarily gram negative infections since 2003. I provided him with a list of pathogens diagnosed since 2003. The most significant pathogen in recent years has been pseudomonas aeruginosa. In respect of non-diagnosis in the last year the problem lies with the laboratory staff. While the microscopy details of two reports can be identical only one will provide a culture. For reasons best known to the laboratory staff no culture has been provided during the last 12 months. In addition “mixed species”is also often reported but not specified .If gram positive pathogens are also involved then alternative antibiotics would also be required. Neither the Director of Labtests nor the general practitioners seem prepared to assist in rectifying this irregularity. In the last few months I have had courses of ciprofloxacillin and romicin and I am still producing sputum, experiencing a nagging cough and a sore chest. . In November 2020 I emailed Labtest scientists stating my concern but received an unsatisfactory response as was the case with the complaint to Labtest Director Dr McAuliffe..
Chapman referred to the recent CT scan as “reassuring….did not think that surveillance going forward for her lung nodule was indicated”
The CT report of October 2016 stated: “ Bilteral apical fibrosis is unchanged.” From time to time I experience serious discomfort in the chest during a period of infection to the point where I have difficulty walking.. This may be attributable to fibrosis and scarring in the lungs and the condition would need to be monitored at least on a yearly basis. Medications are available for this condition. I am afflicted with a cough on an almost permanent basis. My former history of smoking and lung pathogens should also be sufficient reason for continued yearly monitoring .
There also was no significant response from Dr Chapman in respect of the images and reports I had emailed. He conducted an examination of my chest and abdomen but made no comment. Unusually, a nurse was present for the duration of the consultation. Chapman advised my BP was “180/90” which seemed unusual in comparison with recent readings from my medical practice last recorded as 140/80 on 24 November 2020.
A probable enlarged lymph node was evident in the right breast but not diagnosed in a breast ultrasound at Waitemata DHB in 2020 .
I had requested a change of specialist to Dr Brant however on 30 July 2021 I received a reply from Janice Kirkpatrick Operations Manager who advised ‘ I can confirm that we have received your referral and that it has been graded as a Priority 3 to be seen within 4 months. I note that this appointment will be with Dr Alex Chapman. Dr Brant has reviewed your history and is supportive of the current plan of care outlined by Dr Chapman and as such has declined to take over your care’. That is not a very satisfactory outcome.

A pulmonary function test was performed at Waitemata DHB on 12 April 2022. “ Physiologists comment: PFT reason : Bronchiectasis -spirometry results were acceptable and repeatable. Inspired test gas volume for one trial of DLco was < 90% measured VC results may be underestimated inaccurate. Ayesa Kuddus Trainee Physiologist : The FEV1/FVC % predicted was 85”

A specialist’s appointment is scheduled with Dr Sood on 28 March 2023.

Respiratory Clinic Letter

To: Dr Audrey K Thorpe, 16/326 Sunset Road, Mairangi Bay, Auckland 0632 cc:
Ms Vicki Wilson, Flat 7/36 Taharoto Road, Takapuna, Auckland 0622

Dear Dr Thorpe

Problems

1. Recurrent chest infections with recent sputum growth of pseudomonas.
   • HRCT chest and CT sinuses 2020 unremarkable.
   • Previous sputa have grown multiple bacteria over the years including haemophilus, staph aureus, Serratia stenotrophomonas etc.
   • 25 pack year history of smoking stopped 1992.
   • FEV1 1.92 (93%), FVC 2.88 (108%), DLCO of 95% (12th April 2022).
2. Coronary heart disease with LAD stent.
   • Stress echo October 2022 shows normal LV size and systolic function with normal RV size and systolic function. Basal akinetic mid inferol-ateral segments.
3. Rhinosinusitis with last CT in 2020 showing minimal sinus disease.
4. Hypertension.

Current Medications 1. Lisinopril.

2. Aspirin.
3. Ventolin.
4. Carbimazole.
5. Losec.
6. Bendrofluazide.
7. Statins.
8. Azithromycin 500 mg on Monday, Wednesday and Friday for the next three months.
9. NeilMed sinus rinse.

I saw Vicki for the first time in the respiratory clinic. She has previously been seen by multiple respiratory physicians in the past. Vicki lives on her own. She worked in clerical and research jobs. She smoked from 1969 to 1992 averaging 20 cigarettes a day.

She says that she had asthma bronchitis as a child. However, her asthma symptoms improved in later teenage years.

She has always coughed up sputum about half a bottle of mildly purulent sputum which is what she is coughing now. She has not had any haemopty-sis. She is able to walk half an hour on the flat most days. She would get puffed going up hill. She denies any wheeze or definite hay fever symptoms. However, she does complain of some sinus discomfort and blocked nose. She has no symptoms of reflux or weight loss.

Clinically she looks well with recent weight of 60 kg, BMI 24 and oxygen saturation of 99%. She is in sinus rhythm. The chest is clear on auscultation. There is no peripheral oedema.

Recent lung functions from April 2022 are entirely normal.

Impression and Plan
Vicki has had multiple episodes of lower respiratory tract infection/bronchitis. I do note that her recent sputum was growing pseudomonas which has intermediate sensitivity to Ciprofloxacin. She has had a few weeks of high Ciprofloxacin at 750 mg BD. I have discussed the option of using Azithromycin for suppressive treatment. She has agreed to start on Azithromycin three times a week after she has finished the Ciprofloxacin.

I have indicated that the common source of pseudomonas would be either from bronchiectatic airways or from sinonasal disease. We have agreed to repeat her HRCT chest and CT sinuses. She has also agreed to start regular sinus rinse for which I have given her a prescription. I have reassured her that her lung function tests are entirely normal. I have also reassured her that to date there is no suggestion of her having lung cancer, which has been one of the concerns for her. She tells me that her mother passed away at the age of 91 from lung cancer.

We have agreed to meet again after she has had the scans done to discuss things further.

Yours sincerely

Electronically sighted and approved by

Dr Jai Sood MD FRACP
Respiratory Consultant

30/03/2023

ENT
I have for as many years been afflicted with severe sinus infections and on-going pain some of which is attributable to allergies have for as many years been afflicted with severe sinus infections and on-going pain some of which is attributable to allergies
T to allergies A nasal sputum test in 2000 indicated “ large number of gram negative cocci in conjunction with small number of gram positive cocci” The CT sinus miniseries of December 2000 reported that “ “the nasal septum is deviated slightly to the right. The maxillary sinus ostia are narrowed by lateral ethmoid cells Haller’s cells which might predispose to oesteal obstruction with relatively mild degrees of nasal mcosal swelling”
An tion by specialist Dr Dev Tandon at Green Lane hospital in June 2001 reported that “ the nasal mucosa as looking remarkably healthy. He noted small Haller cells in the superior ps of the maxillary antra that seem to have narrowed the oestomeatal complexes to some extent but there was considered to be no significant pathology as such”. The subheading on his res “ delusional about bacterial infection throughout the whole body”
Although he has initially categorically denied having written the comment it is quite clearly evident in the copy of his original report. He did also apologise . However, in his letter to Ms B adviser to the Health and Disability Commissioner dated 4 February 2009 Tandon contradicted his earlier apology with the statement that “ the word “ delusion” was used in the context where it means an unshakable belief in something untrue where such a belief remains firm even when overwhelming proof is presented to dispute it” The middle meati are clear-there was no infective mucous or polyps. There was an accessory ostea bilaterally and the antral mucosa appeared healthy. The nasopharynx appeared unremarkable. The remainder of the upper airway looked healthy” A subsequent MRI scan of the brain and neck was also unremarkable. His recommended a change. in bedding (mattress pillow encasements) and he continuation of exisiting medication as prescribed by the respiratory physician.
A physical check of the external sinuses by GP Dr Thomson in January 2006 indicated “tender sinuses all over and T 36.6”)
In December 2007 a somewhat contradictory CT scan to that of December 2000 reported “that the frontal and maxillary sis were clear with only mild scattered mucosal thickening in scattered anterior ethmoid air cells.
In 2007 during the course of a consultation with yet another ENT specialist( Dr Bartley) my medical history was annotated and areas of muscular tenderness or trigger points examined. .While the here was also brief instrumental check of the sinuses there was no external examination to assess pain.
It seemed to be a matter of priorities . When I began to explain that I had begun to experience a change in the symptoms associated with infection in the late 1980s, namely additional pain in the sinuses, neck stiffness, sleepiness, blood spotting and small blood clots, the specialist suddenly took umbrage and suggested that if “ I was unwilling to listen to an alternative explanation as to what was going on then he would terminate the consultation.” And that is what occurred.
Apart from a briefly referring to“ has grown Pseudomonas as well as Serratia Marcens” (Marcescens) there was no discussion of the gram negative bacterial infections with which I have been afflicted with in recent years” Nor did he consider that another scan of the sinuses would serve much purpose.
As an ENT specialist I would have that an investigation of these quite serious symptoms in the sinuses with possible further investigation of the pain and narrowed maxillary sinus ostia would have been his initial priority with ME symptoms and diet secondary to the main concern The aborting of the consultation was unjustified and tantamount to negligence.
These findings also seem to be at variance with thermography reports of 2003 which specified “focal areas of hyperthermia over both maxillary paranasal sinuses and the medial eye sockets” I am afflicted with almost continuous sinus pain and on occasions have had to use an ice pack on the head . I am also often afflicted with a stiff neck and this inflammation has also been indicated in a thermography report .The latter symptoms can also be indicative of meningitis. Thermography scans are not recognised by the medical profession.
The report of ENT specialist Simcock dated 20 December 2007 stated “ Examination with the fiberscope showed that the nose nasopharynx pharynx and larynx were normal as were the ears. The nasal septum was slightly curved but with good patent nasal airways….. the symptoms were not attributable to infective sinusitis but were referred from myofascial trigger points in the neck-that the post nasal mucus is from vasomotor rhinitis from alternation in the sympathetic nerve supply controlling the nasal membranes…. recommended treatment from either a physio or chiropractor. A CT (Mini Sinuses ) of the sinuses dated 19 December 2007 reported : “ The frontal and maxillary sinuses were reported as clear as were the posterior ethmoid and sphenoid sinuses. There was mild scattered mucosal thickening in both anterior ethmoid air cells. The frontal recesses and osteomeatal complexes are normal. A bone lesion in the base of the skull was not identified.’
The same specialist’s second report was dated 22 January 2008 differentiated between the sinuses and the nose or nasal passages. “ any mucous that you are producing is arising from the nasal passages and not from the sinuses the presence of microorganisms in nasal secretions is not necessarily an indication of infection either in the nose or in the sinuses. In my opinion your symptoms are not arising from any pathology in the sinuses but are being refered to the area of the face in which they are situated. Your tiredness forgetfulness and difficulty with thought processes are much more related to your ME and are not related to any problems arising from your nose or sinuses and are certainly not due to Meningitis. ……except to exclude the nose and sinuses as the origin of your symptoms”
Wikepedia advises that “Another possible complication is empyema .Bacterial or occasionally fungal infection of the skull bones or air sinuses can spread to the subdural space, producing a subdural empyema. The underlying arachnoid and subarachnoid spaces are usually unaffected, but a large subdural empyema may produce a mass effect. Further, a thrombophlebitis may develop in the bridging veins that cross the subdural space, resulting in venous occlusion and infarction of the brain. With treatment, including surgical drainage, resolution of the empyema occurs from the dural side, and, if it is complete, a thickened dura may be the only residual finding. Symptoms include those referable to the source of the infection. In addition, most patients are febrile, with headache and neck stiffness, and, if untreated, may develop focal neurologic signs, lethargy, and coma. The CSF profile is similar to that seen in brain abscesses, because both are parameningeal infectious processes. If diagnosis and treatment are prompt, complete recovery is usual. It can be associated with sinusitis.[2]
.EMed website advises “ if disruption occurs that affects the normal host defenses inside the sinuses those defenses may allow bacteria which are normally present in the nasal passages to enter any of the sinuses . Once there the bacteria may stick to the lining cells and cause a sinus infection. Bacteria that normally cause acute sinusitis are Streptococcus pneumoniae and Staphylococcus aureus”
I have a history of chest and sinus infections –in recent years I have been afflicted with 4 different gram negative strains often in conjunction with gram negative cocci. These details have been relayed to all the ENT specialists that I have consulted. Antibiotics do normally alleviate the symptoms. Specialist assessment would seem to be erroneous. Reference to a small lesion in the right nostril was also omitted from the report.
A CT of the sinuses at Greenlane Imaging on 24 November 2011 reported: “SINUSES. There is no mucosal thickening throghout the paranasal sinuses, which are well aerated.and have normal anatomy. The OMU are patent. The nasal septum is midline and the airway open. No bony or soft tissue abnormality. A linear density in the roof of the mouth /tongue is possibly something patient had in her mouth. Conclusion: No evidence of sinusitis
I visited ENT specialist Mr Shetty of Whangarei on 4 November 2014. I had complained about a combination of symptoms which I h ave experienced most particularly since the late 1980s. They included falling asleep occasionally on public transport, a stiff neck , discomfort in the frontal lobes , mild headaches in conjunction with occasional memory loss.( see also ENT). I had suggested that Ameningitis, or empyema might be the culprits.
Mr Shettys report dated 5 November 2014 is thus: “her most important complaints currently are facial maxillary and frontal pain along with multiple pain points on the scalp chronic postnasal drip and currently using Fess nasal washes. There is no history of any nasal obstruction. She has also shown very mild signs of sinus inflammation in the CT scans which were done in 2000 and 2007” .( A physical check of the external sinuses by GP Dr Thomson of Glen Innes in January 2006 indicated “ tender sinuses all over” Thermography report of 2003 reported “focal areas of hyperthermia over both maxillary paranasal sinuses and indicated a pervasive inflammation over the back of the neck. Thermography is not recognized by the medical profession.
Shetty’s report continued: She does complain of memory loss dull headaches and nasal congestion…(also sleepiness)has shown me the sputum culture which has grown pseudomonas aeruginosa which is sensitive to Ciprofloxacin…..Clinical examination today with anterior rhinoscopy also did not show any polyps or mucopus in the nasal cavity. The oropharynx was normal. Neck palpitation was normal. Miss Wilson requested me to put her case to the public system for fiber optic nasal pharyngolaryngeal evaluation and also to order a CT scan of the paranasal sinuses to investigate further to the sinus pathology’.
I explained that I was virtually prescribed ciprofloxacin on a permanent basis .Shetty erroneousely stated that it was primarily prescribed for chest rather than sinus infections: Website Nature Communications advises : The opportunistic bacterium, Pseudomonas aeruginosa, is extremely skilled at both colonizing and persisting in the airways of patients with lung damage. It has been suggested that the upper airways (including the paranasal sinuses and nasopharynx) play an important role as a silent reservoir of bacteria”. I advised that my previous GP also prescribed Curam Duo as a supplementary treatment however Shetty was not prepared to also prescribe penicillin. Pseudomonas can also result in meningitis and abscesses.
The Centre for disease Control ( CDC) advises: “Because of the risks of severe morbidity and death, effective antibiotics should be administered promptly to patients suspected of having meningococcal disease. Multiple antimicrobial agents, including penicillins, are effective against N. meningitidis.[5] For patients who receive penicillin, eradication of nasopharyngeal carriage with rifampin, ciprofloxacin, or ceftriaxone is recommended prior to discharge from the hospital Shetty had a quick glance at some of the previous reports and took some copies.
On 23 October 2014 Physician Dr Kennedy of Whangarei Kennedy commented “ CT scans of the sinuses in 2000 and 2007 failed to identify significant sinusitis with mild mucosal thickening of the anterior ethmoid air cells” A sinus sputum test has never been previously suggested by either physicians or general practitioners.
ENT specialist Mr Chris Seeley advised in his letter dated 23 January 2015 that “ I will see her in our clinic to discuss her symptoms and look at the scan”. As of June 2015 the appointment had not eventuated and ENT administration as20sistant Ms Marsh apologised for the delay advising in her email dated 10 June2015 “ that we were not sent a copy by our typist” . and instead arranged an appointment with Dr Faumui in early July. I further advised her of my preference for an appointment with Dr Seeley however this never eventuated.
There is a possible abnormality in the area below the sphenoid sinuses detailed in the MRI brain scan of 2015.( see images in neurology-abbreviated version of NZ Health Human Rights)
CT Sinuses: North Shore Radiology 5 August 2020 John Gunn Radiologist
“The maxillary antra are entirely clear with patent ostia bilaterally. (A thermography report dated 2003 referred to “ focal areas of hyperthermia over both maxillary paranasal sinuses which may correlate with reported symptoms of sinusitis.) There is very mild mucosal thickening in the ethmoid air cells and left frontal sinus. The sphenoid sinuses are normal. The nasal airway is normal and the nasal septum deviated. No postnasal space mass. Mastoid air cells and tympanic cavities are normal bilaterally. Conclusion: Minimal nasal sinus disease.”
On 24 September I was advised by the Otorhinolarynology Clinic “that the assessment of your clinical details did not meet the the criteria for an outpatient assessment appointment with a specialist” I am frequently afflicted with both chest and sinus sputums from pathogenic infections.
NEUROLOGY
In May 1988 I received a report from Dr Simpson of Dunedin providing a diagnosis of ME or Myalgic Encephalomyelitisalgic Encephalomyelitis –“ I enclose herewith the results of your blood sample which shows the increase in cup forms typical of most cases of ME. At present nothing is known about who can be converted to normal. You will notice that cells with surface changes were abnormally increased. These cells may respond to evening primrose daily( 6 daily -2 with each meal and for this reason you might gain some improvement by using the supplement . I regret that I cannot be more helpful. Yours sincerely L O Simpson
Symptoms associated with ME include: painful lymph nodes (small glands of the immune system)///stomach pain and other problems similar to irritable bowel syndrome, such as bloating, constipation, diarrhoea and nausea/////sore throat/////sleeping problems, such as insomnia and feeling that sleep is not refreshing///////sensitivity or intolerance to light, loud noise, alcohol and certain foods///psychological difficulties, such as depression, irritability and panic attacks////less common symptoms, such as dizziness, excess sweating, balance problems and difficulty controlling body temperature
My history had included severe sunstroke on one occasion in the 1970’s . An MRI scan of the brain and spine was performed in February 2004. “No brain lesions were shown. All regions were shown to have normal intensity on all sequences apart from a few minor T2 hyperintensities in the cerebral white matter described as of no clinical significance. No abnormality was seen at the craniocervical junction. The spinal cord was normal in appearance with of sign of spinal cord or of any intrinsic spinal cord lesion. There are mild degenerative changes in the lower cervical discs without evidence of spinal cord or nerve root distortion. No paraspinal lesion was seen (See also Orthopaedics) )
On December 6 2007 I consulted a Neurologist Dr Snow. He considered “ the neurological examination was normal. I had a good view of normal fundi. All reflexes were graded 1+ and symmetrical Her blood pressure was 170/90. There were no carotid bruits. I reviewed the MRI scan performed in 2004. The cerebral hemispheres and ventricles were of normal size. There was no evidence for ventricular hypertrophy or temporal lobe atrophy, which has been reported in schizophrenia . There were scattered small T2 hyperintensities. In summary, the scan is essentially normal. Occasional T2 hyperintensities are commonly seen and seldom have pathological significance’. The specialist first viewed the plates on a monitor downstairs and then resting on his knee as he was seated beside me.
In his report dated 5 January 2008 the neurologist further advised “ it is important to understand that there are no specific MRI findings that make a diagnosis of schizophrenia. Thus while there are features associated with schizophrenia, in this case ventricular hypertrophy or temporal lobe atrophy , these are not specific or diagnostic for the condition. In addition these changes are not always found in schizophrenia. For these reasons the diagnosis of schizophrenia is clinical and not based on investigations such as MRI scanning.”
There are many case studies from both Neuro-scientists and Psychiatrists alike all of which, irrespective of any specific diagnostic criteria, clearly denote a significant reduction in grey matter as being a significant aspect of schizophrenia. Logically, behavioral aspects associated with schizophrenia would be non-existent if the brain structure were normal. In this regard MRI scans must be considered invaluable with regard to diagnosis.
The neurologist was dismissive of the thermography scan of 2003 which reported both diffuse and focal areas of hyperthermia extending from the neck to the lumbar region claiming that inflammation was not evident in the MRI scan any any problems with memory loss etc were not entirely abnormal. He made no recommendations as to further investigation
E MedicineHealth advises that “ if a person experiences mild personality changes, headache, altered consciousness, visual problems or seizures infection may have spread to the brain . Coma or death may follow”
An extract from an overseas studies entitled PERIVENTRICULAR WHITE MATTER LESIONS by Timothy Hain stated that ‘ “MRI studies of older person with disequilibrium and gait disturbances of unknown cause often show frontal atrophy and subcortical white matter T2 hyperintense foci” .Radiological findings of the head and spine in neurofibromatosis 1 (Nf!) IN Northern Finland reported the localization of T2 hyperintensities in the cerebellum brainstem supartentorial white matter and optic areas. The supratentorial white matter was affected in 44%. From the clinical point of view T2 hyperintenstities have been regarded as benign lesions. In rare cases malignant evolution of the lesions has also been reported ( Griffiths et al. 1999 Miaux et al. 1997, Crella et al 1997) and the borderline between neoplastic and non-neoplastic lesions has not always been clear ( Raininko et al 2001). Szudek and Friedman (2002) came to the conclusion that the presence of T2 hyperintensities correlated with central system neoplasms other than optic gliomas .In one of the present patients glioblastoma multiforme appeared at the site of a hyperintense lesion affecting partly the optic radiation which had remained unchanged for many years>” The correlation of T2 hyperintense lesions of the brain with learning difficulties behavioral problems seizures and mental retardation has been widely studied but the results have been contradictory ( Ozonoff 1999
In January 2008 a second neurologist Dr Elizabeth Walker reported “ Tests of gait and balance were normal. Cranial nervous system examination was normal. Peripheral nervous system was normal. Blood pressure was 125/75. Normal heart sounds and no carotid bruits-cognitive function was not examined in detail. The scattered T2 hyperintensities are acceptable for her age She considered “ that a diagnosis of schizophrenia could not be refuted on the basis of a normal brain scan-that I should have a consultation with a psychiatrist or neuro-psychiatrist-the MRI scan of the brain performed in February 2004 is within limits of normal for her age” She provided a rather cursory check of the MRI plates and did not have a monitor for viewing. My advice concerning previous severe sun stroke, and the more recent pain experienced in the head and neck together with bouts of memory loss elicited no response.
A study by neurologist and research fellow Stephanie Debette of the BMJ Group dated 26 July 2010 advises: “In conclusion, our systematic review and meta-analysis provides strong evidence that white matter hyperintensities predict the risk of stroke, dementia, and mortality. This emphasises that white matter hyperintensities indicate increased cerebrovascular risk when identified clinically as part of diagnostic investigations and supports their use as an intermediate marker in a research setting. Further studies assessing the impact of progression of white matter hyperintensities on stroke and dementia are needed to help design therapeutic trials incorporating progression of white matter hyperintensities as an intermediate end point. Their discovery should prompt detailed screening for risk factors of stroke and dementia.
What is already known on this topic////Studies have assessed the relation between white matter lesions and risk of stroke, cognitive decline, dementia, and mortality//////The results are, however, partly conflicting//////Heterogeneity of study designs, imaging types, setting, sample size, and follow-up makes the interpretation of published data difficult//////What this study adds: White matter hyperintensities are associated with an increased risk of stroke, dementia, and death/////For stroke and death the association was present in both community based and high risk populations, whereas for dementia the association was significant for community based patients only”
A fall down some concrete steps in the garage in December resulted in my banging the right side of my head against the brick wall. Auckland Radiology’s report dated 24 august 2012 advised: “That no fracture is seen. Alignment is normal. Aeration of the paranasal sinuses is normal”. I met neurologist Dr Willoughby on 5 February 2013. He looked over the plates of the Brain and spinal MRI performed in 2004 together with the skull x ray of August 2012 A monitor was not available to view the plates. His report stated “ there was a bump on the right parietal scalp – a skull x ray showed no fracture. There was no palpable abnormality at the site of the previous scalp haematoma. Neck movements were normal except for mild restriction of lateral flexion.” (Neurologist David McCauley subsequently advised that in his opinion a venous lake was indicated)
I provided Willoughby with a photo dated October 2012 of a rather large nasal blood clot however the neurologist made no comment . I provided the specialist with copies of ENT reports from the early 2000s’ and a report from a Dunedin haematologist dated 1988 confirming a diagnosis of ME complete with drawings of malformed blood cells. Although chronic fatigue fibromyalgia syndrome was mentioned in the specialist’s report any reference to the diagnosis of a Dunedin haematologist which specified myalgic encephalomyelitis and the accompanying diagram of malformed red blood cells was omitted. The neurologist considered the diagnosis to be controversial .
In respect of my sinus head and neck pain the report further stated “CT scans of the sinuses in 2000 and 2007 did not show any evidence of significant sinusitis. ( see also ENT ). In 2004 she had a normal MRI scan of the brain and spinal cord-there were mild degenerative changes in the lower cervical spine. ( see also orthopaedics-lumbar)……has had variable dull headaches ….she has been concerned that her memory and concentration are reduced …there does not seem to any indication of a progressive problem …headaches which are variable but perhaps mainly frontal without any particular pattern through the day or relationship to postural change.”
The temporal arteries were normal. There were no significant abnormalities in the cranial nerves or limbs. Visual acuity was N4 in each eye with normal visual fields optic discs and eye movements. There was marginal impairment of hearing on the left. In the limbs tone was normal and there was no weakness or inco-ordination. Reflexes were normal except for perhaps a slightly reduced left knee jerk. The plantars were flexor. Sensation was normal except for mild impairment of vibration in the toes ( of no particular significance). There was no rest tremor. BP was 140/75 lying and 130/80 standing . Peripheral pulses were just palpable. I do not see an indication for repeat brain scanning. Overall her complex symptoms are of the sort that commonly occur in the chronic fatigue/fibromyaliga syndrome.There seems to be little supporting evidence for recurrent sinusitis or serious URT infections associated with her symptoms….it is possible that L3 or L4 root irritation in the past is the cause of minor asymmetry of the knee jerks. ….there are no features to suggest that recurrent or ongoing meningitis is the cause of her symptoms.”
I enquired about the type T2 intensities in the white matter which were reported in the MRI scan of 2004 however Willoughby gave the matter scant regard stating: “ we all have those” Any reference to them was omitted from his report.. With regard to the the dull headaches, memory wipes, stiff necks and sleepiness that I have been afflicted with bacterial related inflammation is obviously the culprit however he seemed to rather sceptical of this notion and suggested that a course of amtriptiline might be appropriate.!
I had previously met Dr Willoughby in February 2013 and again on 31 December 2013 . His report advised “ Ms Wilson whom I saw in Neurology Day Stay today for assessment of a recent episode of visual disturbance with faintness – a suspected TIA ( Trans ischemic attack).
The recent episode occurred two weeks after an uneventful coronary stent which had improved chest pain. It occurred about an hour after rising in the morning when she was standing in the bedroom. She suddenly experienced patchy black blotches in both visual fields with a feeling of faintness (a symptom that she noted was similar to that experienced when she suffered bleeding from a gastric ulcer in August 2013). The symptoms settled within a few minutes on lying down and have not recurred. With the episode there was no focal weakness or sensory symptoms in the limbs, nor double vision or vertigo. She also did not have palpitations or chest pain and, subsequently, has not had any evidence of further bleeding from a gastric ulcer noted on gastroscopy.
She gave a clear account of recent events. There were no carotid bruits. There were no significant abnormalities on neurologic examination of the cranial nerves or limbs. Visual acuity was N5 in each eye with normal visual fields, optic discs and eye movements. In the limbs there was no focal weakness or incoordination and reflexes were normal. BP was 180/95 mmHg sitting and 160/95 mmHg standing with a regular pulse
Comment:The recent episode of symptoms were of uncertain cause but sound most like a pre-syncopal episode. There were no typical features of a posterior circulation TIA although it is difficult to exclude that – we can reasonably exclude a carotid territory TIA and I do not think there is an indication to repeat a carotid ultrasound although Ms Wilson has wondered about that. A carotid ultrasound in 2003 showed minor plaque in both common carotids withno stenosis. I do not think repeat brain imaging is indicated but we should re-consider that if her course is unsatisfactory.”
The British Medical Journal advises: “About 20-25% (range 17-40%) of the 150 000 ischaemic strokes in the United Kingdom each year affect posterior circulation brain structures (including the brainstem, cerebellum, midbrain, thalamuses, and areas of temporal and occipital cortex), which are supplied by the vertebrobasilar arterial system.1 Early recognition of posterior circulation stroke or transient ischaemic attack (TIA) may prevent disability and save lives, but it remains more difficult to recognise and treat effectively than other stroke types. Delayed or incorrect diagnosis may have devastating consequences, including potentially preventable death or severe disability, The most common causes of posterior circulation stroke are occlusion or embolism from large artery vertebrobasilar atherosclerosis or dissection, and embolism from the heart.11 12 In a large US hospital registry study of 407 patients with posterior circulation stroke, embolism was the most common mechanism (40% of patients); large artery occlusive lesions caused haemodynamic brain ischaemia in 32%; and the remainder of strokes were attributed to in situ small vessel occlusion, other identified mechanisms, or unknown causes.12 Of the strokes attributed to embolism 24% had cardiac source, 14% were caused by to artery-to-artery embolism, and 2% had multiple sources of potential embolism.”12
Dr Starkey assisted Dr Willoughby at the consultation and made reference to a slight drooping on one side of my mouth. Willoughby was somewhat dismissive in his attitude suggesting that it was probably a permanent physical characteristic. There was a quick aside “ its your brain” from willoughby at the end of the consultation. In addition his Irish assistant Mr Starkey advised me to “ go home and have a nice day and I would miss out on the carotid scans at 11.00 am!”
Website Seconds Count advises “As we age, cholesterol and fatty substances build up in our arteries, causing the arteries to narrow and increasing our risk for cardiovascular disease, including both carotid artery disease and coronary artery (heart) disease. The relationship between the two diseases is direct: if you are at risk for heart disease, then you are also at risk for carotid artery disease” ”
Medsafe website advises that subsequent to a TIA:///Imaging of the brain should be performed within 24 hours of symptom onset, as follows[//////4, :Magnetic resonance imaging (MRI) with diffusion-weighted imaging (preferred)//////Noncontrast computed tomography (CT; ordered if MRI is not available)////The cerebral vasculature should be imaged urgently, preferably at the same time as the brain. Vascular imaging for TIA includes the following://Carotid Doppler ultrasonography of the neck////CT angiography (CTA)//Magnetic resonance angiography (MRA)
Website UpToDate states that “SOURCE OF ISCHEMIA — The most common causes of posterior circulation large artery ischemia are atherosclerosis, embolism, and dissection. Dolichoectasia (elongation and tortuosity) of the vertebral and basilar arteries is another occasional cause.
About one-third of posterior circulation strokes are caused by occlusive disease within the large neck and intracranial arteries, which are the vertebral arteries in the neck and the intracranial vertebral, basilar, and posterior cerebral arteries
The proximal portion of the vertebral artery in the neck is the most common location of atherosclerotic occlusive disease within the posterior circulation. Atherosclerosis of the intracranial vertebral arteries and of the basilar artery is also common..)
Dissection of the extracranial and intracranial vertebral arteries is another frequent cause of ischemia within the posterior circulation.
The UC Vascular Centre advises “Vertebrobasilar insufficiency is a condition characterized by poor blood flow to the posterior (back) portion of the brain, which is fed by two vertebral arteries that join to become the basilar artery. The vertebrobasilar arteries supply oxygen and glucose to the parts of the brain responsible for consciousness, vision, coordination, balance and many other essential functions.
Unlike the vertebral and basilar arteries, atherosclerosis and dissection of the posterior cerebral arteries is not common. Most infarcts in the posterior cerebral artery territory are due to embolism from the heart, aorta, or vertebral arteries.
A person with vertebrobasilar insufficiency may experience symptoms lasting for a few minutes or permanent symptom. These symptoms my include:
Loss of vision in all or both eyes Double vision, Vertigo ( spinning sensation), Numbness or tingling ,Nausea and vomiting ,Slurred speech,l oss of coordination, dizziness or confusion,,Trouble swallowing
Whangarei physician Dr Kennedy’s report dated 23 October 2014 was a fairly comprehensive summation of my medical history and recent consultations with other specialists,’ Kennedy alluded to Dr Willoughby’s examination and report of late 2013 concerning my collapse in December 2013 “” he felt that the symptoms in late 2013 were likely presyncopal in nature with no features of posterior circulation TIA or evidence of anterior circulation disease and he did not believe that neuroimaging or carotid Doppler would be helpful. He believed there was an overlay of chronic fatigue/fibromyalgia” I was diagnosed with myalgic encephalomyelitis in 1988 from a blood sample sent to Dr Simpson in Dunedin. Willoughbys report stated that there were no typical features of a posterior circulation TIA although it is difficult to exclude that!
The presyncopal ?symptoms? that Vicki experienced before Christmas 2013 are entirely in keeping with an episode of hypotensive presyncope with systemic symptoms and and absence of focal neurological signs. Should there be further such typical episode it would be appropriate for Vicki to take evasive postural measures lying down elevating the lower limbs and using the musculovenous pump and isometric hand grip to quickly increase blood pressure and improve cerebral perfusion. It there were to be recurring episodes then her antihypertensive treatment should be reviewed.
Vicki has a long history of fleeting and variable tenderness over the scalp frontal temporal parietal and occipital on either side. Vicki has attributed these headaches to low grade psesudomonas meningitis.. Willoughby reassured Vicki that there was no suspicion of Pseudomonas Meningitis or significant sinus disease and felt the symptoms in late 2013 were likely presyncopal in nature with no typical features of posterior circulation TIA or anterior circulation disease and did not believe that neuroimaging or carotid doppler would be helpful. I did not undertake a formal neurological examination. In view of the scalp tenderness I have arranged for an up to date check of ESR and CRP –reactive protein although I believe that giant cell arteritis is improbable.
According to Wikepeida :Giant-cell arteritis (GCA or temporal arteritis or cranial arteritis) or Horton disease is an inflammatory disease of blood vessels most commonly involving large and medium arteries of the head, predominantly the branches of the external carotid artery.
It is a form of vasculitis. It typically causes inflammation of the network of small vessels (vasa vasorum) that supplies the larger arteries. GCA affects arteries of the head and neck, including the three arteries that branch out from the arch of the ascending aorta, and their branches—the thoracic aorta, the axillary arteries, the vertebral arteries, and further on in the head in the ophthalmic and external carotid arteries (the temporal and occipital arteries). It can cause occlusion of the arteries and ischema (tissue death).[1]
LFTs, liver function tests, are abnormal particularly raised ALP- alkaline phosphatase///Erythrocyte sedimentation rate, an inflammatory marker, >60 mm/hour (normal 1–40 mm/hour).//C-reactive protein, another inflammatory marker, is also commonly elevated./Platelets may also be elevated
.Radiological examination of the temporal artery with ultrasound yields a halo sign. Contrast enhanced brain MRI and CT is generally negative in this disorder. Recent studies have shown that 3T MRI using super high resolution imaging and contrast injection can non-invasively diagnose this disorder with high specificity and sensitivity.
I don’t think that Dr Kennedy was aware that I also had a fall in 2012 banging the right side of my head hard against a brick wall .I also had a significant nose bleed and produced a large nasal blood clot about a month after the event. More recently I have noticed that the bony areas of the skull are very sore upon manipulation however this aspect was not referred to in Kennedy’s report
Subdural haematomas are also of concern in the elderly. Taking into account this history one might it prudent to have erred on the side of caution and implemented a brain and/ or carotid scan particularly if the symptoms should recur. Type T2 hyperintensities in the white matter were reported in an MRI scan of 2004 however these are always disregarded by the specialists as insignificant.
A consultation was conducted with Dr Mccauley of 7 Clonbern road Remuera on 29 September 2015. .His report is as follows:
“ The patient looked depressed and sat through a lot of the consultation with her head bowed, avoiding eye contact. She was inclined to mumble and at the same time spoke very rapidly sometimes making it difficult to understand what she was saying. ( I don’t recall this type of assessment in any previous specialist consultations) There was a reduction of normal facial expressivity. but no other features of an extrapyramidal disorder blood pressure was 120/80. Pulse 80 per minute regular – full general examination was not performed. (McCauley provided a fairly extensive testing of my reflexes and apparently did not find anything significantly amiss).
Bilateral prominent palmar erythema was noted over the hypothenar eminences. The skull was normal . Neck movements wre mildly restricted but non-painful. There were no cervical or cranial bruits. There was no meningism. Only minimal scalp tenderness was present requiring significant pressure to elicit it ( Although I requested it, Dr McCauley did not apply significant pressure in his examination of the scalp preferring instead to use only a very light touch!). The temporal and occipital arteries were normal to palpitation with good pulsations. The cranial nervies were normal. In particular her optic fundi were normal. There was no motor or sensory abnormality in the limbs. The tendon reflexes were normal and symmetrical with flexor plantar responses. The patients gait and balance were normal. She was able to stand steadily on a narrow base with her eyes closed, could tandem walk without difficulty and could stand on either leg alone with her eyes closed.”
I showed McCauley a rather poor quality copy of the rear view of a skull x ray undertaken by Auckland radiology when I hit my head against a wall in 2012. McCauley advised “the patient mentioned a fall down stairs in 2012`which resulted in a coccygeal haematoma. She hit her head at that time and began to experience soreness of the scalp particularly in the right occipital region. Ever since that episode the patient has been experiencing “ terrible tenderness of the scalp” which is generalised. In addition she has constant dull pain in the head mostly at the vertex and in the high biparietal region. The patient provided me with photocopy of a plain skull x ray with a venous lake marking she had outlined on a PA view which she is worried is a fracture. I agree with the accompanying x-ray report which the patient provided states there is no fracture seen and I agree with this report based on the photocopy of the single skull projection which she provided.” …
I think it is very unlikely that the patient has any serious underlying intracranial structural cause which accounts for her ongoing troublesome symptoms including scalp tenderness and chronic head pain. This has been present for many years and on that basis one can say with certainty that it is very unlikely here is any serious underlying cause which has not by now declared itself.
I am in agreement with my colleague Dr Willoughby that her symptoms are part of her long-standing chronic fatigue syndrome and fibromyalgia with additional tension headache.” In respect of my collapse at the end of 2013 McCauley considered that “ this event was thought to have been a presyncopal episode rather than a posterior circulation TIA”
In his report dated 31 December 2013 Neurologist Willoughby stated : “There were no typical features of a posterior circulation TIA although it is difficult to exclude that – we can reasonably exclude a carotid territory TIA and I do not think there is an indication to repeat a carotid ultrasound although Ms Wilson has wondered about that. A carotid ultrasound in 2003 showed minor plaque in both common carotids with no stenosis. I do not think repeat brain imaging is indicated but we should re-consider that if her course is unsatisfactory” .
McCauley stated “ that she has a long standing chronic cough of uncertain cause and has chronic rhinosinusitis. Previous sputum cultures at one time grew pseudomonas. He attributed the symptoms of “ neck stiffness.. falling asleep at unusual times and periods of deficient memory to ME or Chronic Fatigue syndrome”( ME syndrome was diagnosed by Dr Simpson of Otago from a blood test in the late 1980s). I had advised McCauley that these symptoms, which I had never previously experienced, were in fact the result of a a particular sinus infection in the late 1980s. He did not refer to this in his report. I have a long history of chest/sinus infections over the last 30-40 years and multiple different gram negative infections diagnosed since 2003. I have been permanently afflicted with pseudomonas aeruginosa during the last 12-18 months . I made a suggestion as to what might be afflicting me in the head and sinuses i.e. possibly subdural empyema, or meningitis. Other than to suggest that empyema was a condition affecting the lungs there was otherwise no discussion as to the possible nature of the problem.
I also discussed the possibility of another carotid ultrasound which overseas sources suggested were generally recommended in conjunction with heart procedures. The specialist seemed opposed to this.. I also showed the specialist the thermography body scan from 2003 which clearly shows significant inflammation .The results of a few of of the previous ESR and CRP tests have been in excess of the maximum. McCauley made no comment. I asked if he would be prepared to prescribe antibiotics however he considered that was the task of the general practitioner.
McCauley agreed to provide a referral for a brain MRI to Mercy radiology however it wasn’t until approximately 10 days later that the referral was confirmed by the radiology group. I had requested a change to a head /neck scan however this elicited no response. He refers to the “ normal MRI brain scan of February 2004” – although he did not allude to “a few minor type T2 hyperintensities in the white cerebral matter of no clinical significance”
An article from the Journal of th e American Heart Association dated September 2015 states: “There is strong evidence that (White Matter Hyperintensities (WMH) are clinically important markers of increased risk of stroke, dementia, death, depression, impaired gait, and mobility, in cross‐sectional and in longitudinal studies. They associate with brain damage such as global atrophy and other features of small vessel brain damage, with focal progressive visible brain damage, are markers of underlying subvisible diffuse brain damage,and predict infarct growth and worse outcome after large artery stroke.hey could be considered as the neuroimaging marker of “brain frailty”.
I had requested a head/neck scan from McCauley however he has a requested a brain scan only. Although he had advised me that he would be onforwarding a request for the scan to radiology the day after the consultation there seemed to be a delay of approximately 10 days before it was received at Mercy Radiology. A brain MRI was performed at Mercy radiology on 27 October 2015 by Dr Gerard Deib. His report is as follows: “ Comparison none ( I provided plates from the former MRI performed in 2004 to the radiographer however apparently they were not consulted by Deib). Diffusion weighted imaging not performed as there is a mechanical fault with the sequence.
Findings: There are a few small foci of periventricular and subcortical T2 FLAIR hyperintensity non- specific in appearance likely due to cerebrovascular small vessel disease. Dilated perivascular space is noted in the lentiform nucleus bilaterally. No evidence of focal intracranial abnormality with no definite evidence of infarct haemorrhage or space occupying lesion. Mild to moderate enlargement of the extracerebral CSF spaces with commensurate enlargement of the ventricles. Orbits and globes unremarkable. Mastoid air cells and paranasal sinuses are clear. Orbits and globes are unremarkable . No abnormal contrast enhancement .
Impression: Non- specific white matter change- Mild to moderate involutional change-No focal intracranial abnormality to account for patients symptoms
There was no subsequent communication or report from the neurologist Dr McCauley subsequent to the MRI brain scan. In addition it would appear that there are additional areas of non-diagnosis:. Image 90/176 from the MRI scan (the superior saggital sinus?) would seem to indicate a possible small thrombus ( inverted small triangle-“ the delta sign”). Likewise a diagnosis of leptomeningeal enhancement ( indicative of meningitis) and diffuse enhancement of the pachymeninges also evident, seems to be lacking. Upon recent reappraisal a greyish/white slightly variegated lesion?/intracerebral haematoma?//abscess? in the upper left is also evident. This is not however apparent in the CT of the head/brain performed at NDHB in January 2018.
Timothy Hain MD advises that treatment for periventricular white matter lesions include:
Treatment: Control vascular risk factors — especially labile (variable) //// hypertension Pyridoxine (vitamin) supplement///Migraine prevention treatment — especially “vascular” agents such as verapamil and beta-blockers
Physical therapy — especially fall counseling –Adjustment of medications
RADIOPAEDIA: Leptomeningeal enhancement Dr Bruno Di Muzio and Dr Hani Salam: Leptomeningeal enhancement refers to a diffuse or focal gyriform or serpentine enhancement that can be seen in the following conditions:
Diffuse Meningitis/////pyogenic meningitis//viral meningitis///tuberculous meningitis(can also be focal)//CNS cryptococcal infection//carcinoma of breast or lung, melanoma)//post-ictal hyperemia//infarction: subjacent acute (leptomeningeal collaterals) or subacute//////lymphoma//meningitis(e.g. tuberculous)//encephalitis//neurosarcoidosis//postoperative scar//vasculitis
Radiographics advises “ Vascular causes of serpentine (gyral) enhancement include vasodilation after reperfusion of ischemic brain, the vasodilatation phase of migraine headache, posterior reversible encephalopathy syndrome (PRES), and vasodilatation with seizures (19–21). Serpentine enhancement from breakdown of the blood-brain barrier is most often seen in acutely reperfused cerebral infarction, subacute cerebral infarction, PRES, meningitis, and encephalitis. The primary distinction between vascular and inflammatory causes of the serpentine pattern of enhancement relies on correlation with clinical history and the region of enhancement. An abrupt onset of symptoms suggests a vascular cause, whereas a more indolent history and nonspecific headache or lethargy suggests inflammation or infection. Gyral lesions affecting a single artery territory are often vascular, whereas inflammatory lesions may affect multiple territories. The most common vascular processes affect the middle cerebral artery territory (up to 60% of cases). However, PRES lesions usually locaize in the posterior cerebral artery territory (21–27).
Meningitis is usually characterized as acute, sub-acute and chronic. In respect of gram-negative meningitis caused by pseudomonas aeruginosa infections Medsafe recommends that “ a gram stain and culture of CSF if meningitis is suspected” Medscape’s recommendation are : “ Ceftazidime or cefepime Alternatives: Aztreonam, meropenem, ciprofloxacin”
The Merck manual advises : “The symptoms of chronic meningitis are similar to those of acute bacterial meningitis, except that they develop more slowly and gradually, usually over weeks rather than days. Also, fever is often less severe. Symptoms may last for years. Some people get better for a while, then worsen (relapse).
Headache, confusion, a stiff neck, and back pain are common. People may have difficulty walking. Weakness, pins-and-needles sensations, numbness, paralysis of the face, and double vision are also common. Paralysis of the face, double vision, and hearing loss develop when meningitis affects the cranial nerves (which go directly from the brain to various parts of the head, neck, and trunk)”.
ASK .COM: The function of the lentiform nucleus involved in maintaining the muscular tone of the body and assisting in controlling movement, mainly of the limbs of the human body. In addition is it involved in making find precision movements by reducing any extraneous or unwanted movements. The lentiform nucleus is formed by a cluster of neuron bodies deep within the brain. It is composed of two distinct structures: the globus pallidus and the putamen. The lentiform nucleus is part of a larger unit known as the basal ganglia. The putamen is thought to have an additional role in memory formation, more specifically, muscle memory. When you are learning to ride a bike you are using your putamen. The globus pallidus serves to help make fine movements and inhibit abnormal movements. Damage to this structure can cause involuntary limb shaking like that in Parkinson’s patients.
EM CONSULTE: Involvement of the lentiform nucleus occurs mainly in association with toxic, metabolic and chronic vascular disorders.
RADIOGRAPHICS: West Nile fever typically demonstrates bilateral involvement of the thalamus and the caudate and lentiform nuclei
WIKEPEDIA: Dilation is most commonly and closely associated with aging. Dilation of perivascular spaces has been shown to correlate best with age, even when accompanying factors including hypertension, dementia, and white matter lesions are considered.[13] In the elderly, such dilation has been correlated with many symptoms and conditions which often affect the arterial walls, including vascular hypertension, arteriosclerosis, reduced cognitive capacity, dementia, and low post-mortem brain weight.[6].[6] When dilated VRS are observed in the corpus callosum, there is generally no neurological deficit associated. They are often observed in this region as cystic lesions with cerebrospinal-like fluid.
Symptoms of dilation: Extreme dilation has been associated with several specific clinical symptoms. In cases of severe dilation in only one hemisphere, symptoms reported include a non-specific fainting attack, hypertension, positional vertigo, headache, early recall disturbances, and hemifacial tics. Symptoms associated with severe bilateral dilation include ear pain (which was reported to have resolved on its own), dementia, and seizures. This data was compiled from case studies of individuals with severe VRS dilation.[6] Considering the anatomical abnormality presented in such cases, these findings were considered surprising in that the symptoms were relatively mild. In most cases there is in fact to mass effect associated with some VRS dilation. An exception to the mildness of clinical symptoms associated with VRS dilation is when there is extreme dilation in the lower mesencephalon at the junction between the substantia nigra and cerebral peduncle. In such cases, mild to moderate obstructive hydrocephalus was reported in most patients. Associated symptoms ranged from headaches to symptoms more severe than those just discussed in the cases of dilation in the cerebral hemispheres.[6] Other general symptoms associated with VRS dilation include headaches, dizziness, memory impairment, poor concentration, dementia, visual changes, oculomotor abnormality, tremors, seizures, limb weakness, and ataxia.[2] These symptoms are also similar to those experienced in 2013 which were classified as a probable pre-syncopal attack /or Trans-ischaemic attack (TIA).
Radiopaedia.org: Virchow-Robin spaces (VR spaces) also known as perivascular spaces, are spaces surrounding the walls of arteries, arterioles, veins, and venules as their course from the subarachnoid space through the brain parenchyma.
These spaces do not communicate directly with the subarachnoid space but they are filled wit interstitial fluid which behaves similarly to CSF in MR.
Dilated perivascular spaces consist of regular cavities containing an artery. The mechanism that occurs is not well known but there are many hypotheses in study. It s considered to be dilated when the size exceeds 2 mm visualized better in T2 weighted images. Rarely the size of the space is so large that produces mass effect on the adjacent brain parenchyma and it can cause hydrocephalus. The prevalence increased with aging, and in some cases this perivascular atrophy of ccerebral tissue, generates lacunae and is called “ etat crible”
There are no flow restriction in diffusion-weighted images and they don’t enhance after the administration of contrast material. The key to differentiate it from other pathologies is that VR spaces are hypointense in sequence FLAIR unlike other entities in the differential diagnosis.
Associated disorders: Dilation is a typical characteristic of several diseases and disorders. These include diseases from metabolic and genetic disorders such as mannosidosis, myotonic dystrophy, Lowe syndrome, and Coffin-Lowry syndrome. Dilation is also a common characteristic of diseases or disorders of vascular pathologies, including CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy), hereditary infantile hemiparesis, retinal arteriolar tortuosity and leukoencephalopathy, migraines, and vascular dementia. A third group disorders typically associated with VRS dilation are neuroectodermal syndromes. This includes polycystic brains associated with ectodermal dysplasia, frontonasal dysplasia, and Joubert syndrome. There is a fourth miscellaneous group of disorders typically associated with dilation which include autism in children, Megalencephalopathy, Secondary Parkinson’s Disease, recent-onset Multiple Sclerosis and chronic alcoholism. Because dilation can be associated with several diseases but also observed in healthy patients, it is always important in the evaluation of VRS to study the tissue around the dilation via MRI and to consider the entire clinical context.[6]
WIKIPEDIA:
Cerebral edema or cerebral oedema is excess accumulation of fluid in the intracellular or extracellular spaces of the brain. Signs and symptoms: Symptoms include nausea, vomiting, blurred vision, faintness, and in severe cases, seizures and coma. If brain herniation occurs, respiratory symptoms or respiratory arrest can also occur due to compression of the respiratory centers in the pons and medulla oblongata. Certain changes in morphology are associated with cerebral edema: the brain becomes soft and smooth and overfills the cranial vault, gyri (ridges) become flattened, sulci (grooves) become narrowed, and ventricular cavities become compressed.
Cerebral edema can result from brain trauma or from nontraumatic causes such as ischemic stroke, cancer, or brain inflammation due to meningitis or encephalitis.[1]The blood–brain barrier (BBB) or the blood–cerebrospinal fluid (CSF) barrier may break down, allowing fluid to accumulate in the brain’s extracellular space.
Altered metabolism may cause brain cells to retain water, and dilution of the blood plasma may cause excess water to move into brain cells. Fast travel to high altitude without proper acclimatization can cause high-altitude cerebral edema (HACE)
5 October 2015
Dr Catalina Wong
Quay Med Accident & Medical Clinic
68 Beach Road
AUCKLAND
Dear Dr Wong
Re: Ms Vicky WILSON
Date of Birth: 02 07.1949.
62 West View Crescent, Onerahi, Whangarei 01 10.
Thank you for referring this 66 year old woman whom I saw on 29.09.15 for a neurological opinion.
She has a very complex past medical history. The patient brought along copious past medical records which she had very kindly made the effort to photocopy and to collate under various medical specialties. The patient is retired. She worked in clerical jobs and tells me that at one time, she was employed as a research assistant for the SIS.

To summarise her past medical history, she has a very long-standing problem which is thought to be the chronic fatigue syndrome. In 1981 the fatigue was especially prominent and was accompanied by the first development of palmar erythema and erythema nodosum. The cause for this was never ascertained. She has had a long-standing chronic cough of uncertain cause and has chronic rhinosinusitis. Previous sputum cultures at one time grew pseudomonas. There is also a hisory of a solitary pulmonary nodule in the right lower lobe of uncertain nature. She has had thyrotoxicosis, mammary fibroadenosis, multiple coronary stenting, a gastric haemorrhage secondary to gastric ulcer, hypertension and hyperlipidaemia.
Beginning in the early 1990s, the patient began to experience neck stiffness which later extended into her hands and legs and was associated with falling asleep at unusual times, for example in the bus. She also had periods in which her memory seemed to be deficient. These symptoms were reminiscent of what was initially called ME in the 1980s with the diagnosis subsequently revised to chronic fatigue syndrome. The patient mentioned a fall down stairs in 2012 which resulted in a coccygeal haematoma. She hit her head at that time and began to experience soreness of the scalp, particularly in the right occipital region.

Six months after her gastric haemorrhage towards the end of 2013, the patient experienced sudden patches in her vision bilaterally and then collapsed because she could not stand up. There was no loss of consciousness. She was seen by a colleague in the Neurology Outpatients Clinic at Auckland City Hospital on 31.12.13. The event was thought to have been a presyncopal episode rather than a posterior circulation TIA. ( A TIA wasn’t totally disregarded by Dr Willoughby) Ever since that episode, the patient has been experiencing terrible tenderness of the scalp which is generalised. In addition, she has a constant dull pain in the head mostly at the vertex and in the high biparietal region.

The patient was seen by my colleague, Dr Willoughby, earlier in 2013 because of these symptoms which were thought to be features of the chronic fatigue syndrome and associated fibromyalgia. It is the persistence of the patient’s scalp tenderness and head pains which concern her. She mused that her chronic sinusitis and chest infections might have given rise to chronic meningitis. She told me that this had been a long-standing concern. The patient is a reformed smoker. She has a small alcohol consumption.

Current medication includes carbimazole, omeprazole, cilazapril, Atorvastatin and Ciprofloxacin.

An accompanying x-ray report which the patient provided, states there is no fracture seen and I agree with this report based on the photocopy of the single skull projection which she provided.
On Examination :
The patient looked depressed and sat through a lot of the consultation with her head bowed, avoiding eye contact She was inclined to mumble and at the same time spoke very rapidly, sometimes making it difficult to what she was saying. There was a reduction of normal facial expressivity but no other features of disorder. Blood pressure was 120/80. Pulse 80 per minute, regular. Full, general examination was not performed. Bilateral prominent palmar erythema was noted over the hypothenar eminence The skull was normal. Neck movements were mildly restricted but non-painful. There were no cervical or cranial bruits. There was no meningism. Only minimal scalp tenderness was present, requiring significant pressure to elicit it. The temporal and oécipital arteries were normal pulsations. The cranial nerves were normal. In particular, her optic fundi were normal. There was no motor or sensory abnormality in the limbs. The tendon reflexes were normal and symmetrical with flexor plantar responses. The patient’s gait and balance were normal. She was able to stand steadily on a narrow base with her eyes closed, could tandem walk without difficulty and could stand on either leg alone with her eyes closed. This patient provided me with a photocopy of a plain skull x-ray with a venous lake marking she had outlined on a PA view which she is worried is a fracture.
Opinion & Recommendations
I think it is very unlikely that the patient has any serious underlying intracranial structural cause which accounts for her ongoing troublesome symptoms including scalp tenderness and chronic head pain. This has been present for many years and on that basis one can say certainty that it is very unlikely there is any serious underlying cause which has not by now declared itself. It is noted that the patient had a normal MRI scan of her brain and spine in February 2004 which is very reassuring. Chronic meningitis is very unlikely

I am in agreement with my colleague, Dr Willoughby, that her symptoms are part of her long standing chronic fatigue syndrome and fibromyalgia with additional tension. Effective a disorder is, as you know, extremely difficult, particularly when its as long-standing and as this patient’s. The only suggestion I have in regard to this would be treatment a tricyclic such as nortriptyline, beginning with a low dose of 5 mg per day gradually increasing up to 30 or 40 mg if possible.
Because of the concern the patient’s symptoms cause her. I have arranged for her to have a repeat MRI scan of her head, but anticipate this will prove to be normal. If so, no additional investigations are planned,
I have not made any follow-up arrangements to see the patient again and will communicate the results of the MRI scan to both yourself and the patient.
Kind regards
Yours sincerely David McAuley
Another consultation was scheduled with neurologist Alison Charleston on 10 May 2016. I had emailed Ms Charleston with copies of images and reports on 1 April 2016 which I had hoped she would discuss at the consultation however she claimed she was unable to find them on her computer . Receipt of the emails were confirmed by the receptionist Helen Kilpatrick at the practice on 1 April 2016 “Thanks Vicki. Received both of your emails and I have passed these on to Dr Charleston.”
I had advised Charleston that In adddition to a diagnosis of myalgic encephalomyelitis in 1988 by Dr Simpson in Dunedin I also experienced a stiff neck, slight memory impairment, and drowsiness in conjunction with a bout of flu in about the same year.. I subsequently experienced quite severe headaches requiring an ice pack. In her report dated 10 May 2016 Charleston referred to “a bout of “ influenza in the late 1980s-she felt unwell with a stiff neck headache and excessive drowsiness. She had memory lapses”. These symptoms have been attributed to chronic fatigue syndrome” These symptoms would more likely to have been be synonomous with meningitis as opposed to encephalomyelitis and have been on-going in subsequent years.
I produced two copies of images from the MRI brain scan of October 2015 one of which clearly indicated “leptomeningeal diffuse or focal gyriform or serpentine enhancement” Charleston glanced at the image and suggested that “ veins” might be the cause! She did not discuss the MRI report.
In adults and elderly patients, bacterial meningitis symptoms may include the following: Sudden high fever.///Stiff neck//Confusion///Headache///Drowsiness//Irritability///Stroke
“Miss wilson describes a dull discomfort felt at the top of and back of her head-the discomfort is constant she had a normal appearing scalp and I could not identify any tenderness despite firm pressure. She was disappointed that I was not prepared to press hard enough to elicit it” . The cranial vessels were all normal, pulsatile and non-tender and there was no meningism. She had discomfort on rotation of her neck and lateral bending. The range of movement was restricted consistent with her age”. She examined my head but like Dr McCauley did not resort to firm pressure as I had requested declining on the basis “ that she might hurt me”.! “On neurological examination she had a somewhat flat effect with reduced eye contact but there was no definite hypomimia or bradkinesia. Her speech was normal . Cranial nerve examination was normal There was no drift or tremor. Muscle tone was variable. Power, rapid alternating movements and co-ordination were normal. Reflexes were present and symmetrical. She had a strong withdrawal reaction to the plantar test.
She walked a little slowly with a slight stoop. However she was able to pivot turn and could tandem walk well. Romberrg’s test was negative and she was able to stand easily on either leg with her eyes closed. Miss Wilson presents with symptoms suggestive of tension type headache. The neurological examination does not suggest any underlying neurological disorder. The very long history is in support of a benign cause. I think there is some degeneration in her cervical spine and this may be contributing to the development of discomfort in her head as the day goes on.
Miss Wilson is very concerned about apparent abnormalities that she has identified on her MRI scan. As promised I have spent time reviewing the MRI scan in detail with the assistance of the skilled neuro-radiologists at Auckland Hospital. I can confidently say that they found no evidence of raised CSF pressure, venous sinus thrombosis or cerebral abscess. The appearance Miss Wilson interpreted as indicating leptomeningeal enhancement is normal appearance after the administration of contrast .Dilated perivascular spaces mentioned in the report are a normal finding . In addition her nasal sinuses appeared normal . In summary there are no signs that Miss Wilson is suffering from a chronic meningitis.z”
The MRI report clearly specified “ mild to moderate enlargement of the extracerebal CSF spaces and commensurate enlargement of the ventricles which could indicate “Hydrocephalus a condition in which excess cerebrospinal fluid (CSF) builds up within the ventricles. of the brain and may increase pressure within the head’:
I had suggested that intercranial pressure (ICP) might be an obvious issue and that a prescription of prednisone or an alternative medication to help reduce any swelling might be in order. Charleston didn’t think it was necessary nor did the general practitioners.
I had advised that there is excellent comparative imaging available on the internet however Charleston cautioned against too much reliance on “ Google”. Her hourly fee was $430.00!
On 20 December 2017 I was hit on the head by a brass table in my storage unit. I have suffered from mild to moderate headaches and twinges since then. A Ct of the head was performed On 8 January 2018 at NDHB ED . On 8 January 2018 ED Radiologist Albert Eshun advised that “neither skull fracture nor haemorrhage were detected” However after studying the video of the scan it does appear that at least a fracture is evident with a possible small haemorrhage . I emailed the images to Dr Cameron HOD of ED Whangarei Hospital whose reply is detailed below:
13 February 2018
Dr Scott Cameron/ Emergency Department//Whangarei Hospital
Dear Sir,
I received a blow on the head from a heavy brass table in a storage on 20 December 2017. A CT of the head was performed at ED
Whangarei Hospital on 8 January 2018. The report by radiologist Mr Eshun clearly stated that there were no fractures . I have enclosed frames from the video which clearly show fractures as well as a nodule in the lateral ventricle in the brain. I am still afflicted with mild headaches.
An MRI brain was performed at Mercy Radiology in October 2015 and again it appears that neither leptomeningeal enhancement (synonomous with meningitis) nor a posssible thrombus in the superior sagittal sinus region ( also an obscure grey area above the thrombus )were not reported. The reports are enclosed.
There was no communication from neurologist Dr McCauley subsequent to the scan and a later consultation with Dr Alison Charlesworth was also non productive.
Yours sincerely, Vicki Wilson
Scott Cameron (NDHB) Feb 13 (2 days ago)
Hi Vicki
I am sorry to hear about your ongoing symptoms. Thank you for sending me all of this information. I have looked over the images and I do see some vascular channels and some arachnoid granulations (where cerebrospinal fluid is created), but I do not see a fracture. I am happy that your MRI was normal, and that the report and exam from Dr Charlesworth was reassuring, and I wish you a full recovery.
Where there any ED issues that I can address?
Cheers Scott cameron HOD, ED
I visited North Shore Hospital on 6 May 2020 with a chest complaint. The result of a neurological test is as follows: “GCS 15 ( eyes verbal and motor responses-maximum 15-fully awake patient-nil focal”
Subsequent to a request from my General Practitioner Dr Thorpe I was referred to the Neurology Department at ADHB. I emailed copies of relevant reports and images including the MRI images of 2015 to both Dr Bergin and Dr Anderson. I also received a reply from Dr Wong.
On 1 September Dr Bergin advised via email: “Dear Vicki I have read through the letters you have provided and the e-mail below.I do not think there is any point in your coming to see me, as I do not believe my opinion will differ from those of the other neurologists you have seen in the past. Despite your ongoing symptoms, I do not think it is likely that you have chronic meningitis, and I would be very unlikely to recommend any further investigations. Kindest regards Peter Bergin”
On 18 September Dr Neil Anderson advised that “ I have asked for the letters to be forwarded to the triaging neurologist.”
On 24 September 2020 neurologist Dr Wong stated “Thank you for your recent referral letter. The department of Neurology is currently receiving many more referrals than can be seen. Some patients cannot be seen at all, and some must wait many months to be seen, which delays treatment. Your referral has been triaged by two neurologists to a Non-contact Consultation. This means we have not arranged a clinic appointment, but instead provide the following advice based on the information in the referral letter. If Vicki Wilson’s condition is not addressed by the advice below, or if there are further developments please send a new referral letter and we will re-triage accordingly. You referred Vicki Wilson, a 71-year-old woman with a long history of headaches and head pains, which affect her memory. She fell and struck her head in 2012 and there is a possible history of meningitis. She had an MRI scan in 2015 at Mercy MRI and a CT scan in 2018 at Whangarei Hospital. Subsequently she had contacted our department by e-mail. She outlined a number of her concerns primarily regarding failure to report/pick up a skull fracture, a meningeal disorder including meningeal enhancement, a superior sagittal sinus thrombosis, and bleeding in the brain.
I have reviewed her MRI scan from 2012 and a CT scan from 2018 at our Neuroradiology meeting. The MRI brain scan and CT brain scan are normal for her age. There is no evidence of a skull fracture, meningeal enhancement or any other meningeal disease process, brain haemorrhage/bleed, or thrombus in venous system. Hence, we can confidently reassure Vicki Wilson that her two brain scans are normal and allay her of her concerns about missed diagnoses?. She included copies of her consultations with Dr McAuley, Dr Charleston, and Dr Willoughby in her e-mail. There is also a reference to an assessment by Dr Snow but a report was not included in her e-mail. She has been seen by three, possibly four, neurologists. I do not think there is anything further that our review will add to the reassurance we can provide after reviewing her brain imaging with a neuro-radiologist. Yours sincerely Edward Wong Neurologist Department of Neurology “
I think Dr Wong has ignored salient facts concerning abnormal aspecs of the MRI brain scan of 2015 which are evident in copies of the images extracted from the MRI brain scan of 2015 and attached to the email. ( See Facebook). He has however left the way open for a re-referral.
On 8 December I received an email from Consumer Liaison ADHB: “In respect to the email below the service has reviewed your and they advise that from reading of the two GP referral letters 11/8/20 and 24/11/20 as well as your correspondence, your symptoms remain the same as those assessed by Dr McAuley and Dr Charleston.Given the chronicity and nature of the symptoms, normal brain imaging and two prior neurological assessments, the service does not believe further neurological assessment is likely to be beneficial. However, please be reassured that if you are experiencing new symptoms then it is appropriate for you to see your GP. The nature and duration of the new symptoms, along with relevant clinical findings, should be conveyed in a further referral letter.I trust this information is helpful.
Kind Regards
Donna Deans
Consumer Liaison Coordinator, Clinical Quality & Safety
Auckland District Health Board”
A reply from Dr Kilfoyle neurologist dated 9 December 2020 is detailed below:
“Thank you for your referral letter dated 24 November. I have reviewed your referral letters of 24 November and 11 August. I have also reviewed email correspondence sent by Vicki to Consumer Liaison. From my reading of the referral letters and this correspondence, the symptoms are similar to those assessed by Dr McAuley and Dr Charleston. Given the chronicity and nature of the symptoms, normal brain imaging (we do not agree with the patient’s assertion that the MRI is abnormal) and two prior neurological assessments, we do not think that a further neurological assessment is likely to be beneficial. If there are new symptoms the nature and duration of the new symptoms, together with the relevant clinical findings should be conveyed in a further referral letter from the patient’s general practitioner. We do not believe that the MRI in 2015 requires further investigation after reviewing this carefully in our combined neuroradiology conference. Yours sincerely Dr Dean Kilfoyle Neurologist Auckland City Hospital”
On 18 March 2021 GP Dr Thorpe agreed to request a consultation with Dr Snow at ADHB. Upon a subsequent enquiry I was advised by the scheduler that the referral had once again been placed in triage It is unclear whether the referral reached Dr Snow as I was advised by the scheduler that the referral had once again been placed in triage .I have received further advice of another rejection provided on this occasion by way of a letter dated 12 May 2021 from Neurologist Dr Bose.
Labtests renal function tests for sodium :11/11/2021 129////16/2/2022 131/////134 * 5/5/2022 ( 135-145 range)////23/211/2022 134 mmol/L ( 135 – 145 ) / 129L ////////16/2/2022 131 L ///// Waitemata DHB 31/3/2023 Sodium 128 mmol/L L 135-145
What level is mild hyponatremia?
Joint European guidelines classify hyponatremia in adults according to serum sodium concentration, as follows : Mild: 130-134 mmol/L.
Moderate: 125-129 /mmol/L. Profound: < 125 mmol/L.16/07/202 Medical News today advises: Mild hyponatremia may not cause symptoms, but when it occurs, can include: confusion,sluggishness.a headache fatigue and low energy

Moderate hyponatraemia. Consider drug causes of urine losses or SIADH – and other (pathological) causes of SIADH. Other causes of hyponatraemia include severe liver disease, nephritis, GI losses, CCF, chronic hyperglycaemia, adrenal failure. Suggest early morning urine sodium. Severe hyponatremia (< 125 mEq/L) has a high mortality rate. In patients whose serum sodium level falls below 105 mEq/L, and especially in alcoholics, the mortality is over 50 Severe symptomatic hyponatremia is associated with grave consequences including cerebral edema, brain herniation, seizures, obtundation, coma, and respiratory arrest. However, rapid correction of chronic severe hyponatremia may lead to osmotic demyelination syndrome (ODS) and even death. 6/11/2019

Muhammad Yasir1; Oren J. Mechanic2.Affiliations:1 Allama Iqbal Medical College/JHL, Lahore and Harvard Medical School/BIDMC advise:
“Syndrome of inappropriate antidiuretic hormone ADH release (SIADH) is a condition defined by the unsuppressed release of antidiuretic hormone (ADH) from the pituitary gland or nonpituitary sources or its continued action on vasopressin receptors. The condition was first detected in two patients with lung cancer by William Schwartz and Frederic Bartter in 1967. They developed the classic Schwartz and Bartter criteria for diagnosing SIADH, which has not changed. SIADH is characterized by impaired water excretion leading to hyponatremia with hypervolemia or euvolemia. Most commonly, SIADH occurs secondary to another disease process elsewhere in the body.
Idiopathic SIADH is more common in patients over 65 years of age, and mild to moderate hyponatremia in such patients may contribute to fractures in addition to a higher risk of falls and gait problems.
History must include inquiry about head injury, chronic pain, smoking, weight loss, pulmonary symptoms, drug intake, or substance abuse (particularly heroin and ecstasy), in addition to all the above-mentioned symptoms. The clinicians should evaluate the source of excess fluid, and the chronicity of the condition merits consideration.
Conditions Frequently Leading to SIADH:Central nervous system disturbances
Malignancies:
Drugs: Less commonly, non-steroidal anti-inflammatory drugs (NSAIDs), opiates, interferons, methotrexate, vincristine, vinblastine, ciprofloxacin, haloperidol, and high dose imatinib have been linked with SIADH.
Pulmonary disease: Pulmonary diseases, particularly pneumonia (viral, bacterial, tuberculous), can lead to SIADH by unknown mechanisms. A similar response has infrequently been seen in patients with asthma, atelectasis, acute respiratory failure, and pneumothorax.profloxacin, haloperidol, and high dose imatinib have been linked with SIADH.
SIADH complications will hinge on how low blood sodium levels become. Potential complications include: Headaches- Memory problems- Depression- Tremors -Muscle cramps
More severe potential complications include: Respiratory failure- Seizures- Hallucinations- Coma -Death”
Medsafe advises: Hyponatraemia occurs when the sodium level in the blood is low. It is primarily a disorder of water balance usually associated with a disturbance in the hormone that regulates water balance, vasopressin (also commonly called antidiuretic hormone [ADH])1.
Symptoms of Hyponatraemia
Symptoms can range from mild and non-specific to severe and life-threatening (Table 1). The severity of symptoms depends on many factors including the duration of the condition, serum sodium levels and the acute or chronic nature of onset2.
Severe symptoms are caused by cerebral oedema and increased intracranial pressure due to the movement of water into brain cells1.
Table 1: Symptoms of hyponatraemia by severity1
Severity Symptoms
Moderate Nausea without vomiting
Confusion
Headache
Severe Vomiting
Cardiorespiratory distress
Abnormal and deep somnolence
Seizures
Coma (Glasgow Coma Scale ≤8)
Determining the Cause of Hyponatraemia
Hyponatraemia occurs when the patient has excess free water relative to serum sodium levels2. It can be categorised according to the patient’s extracellular fluid volume status1,2.
Euvolaemic (normal fluid status): Possible causes include medicines, syndrome of inappropriate ADH secretion (SIADH), central nervous system disorders, secondary adrenal insufficiency, pulmonary diseases, hypothyroidism and primary polydipsia.
Hypervolaemic (fluid overload): Possible causes include heart failure, nephrotic syndrome, renal failure, Cushing syndrome and saline infusions.
Hypovolaemic (fluid depletion): Possible causes include vomiting, diarrhoea, cerebral salt wasting, pancreatitis, burns, primary adrenal insufficiency and the Diuretics are one of the most common causes of hyponatraemia4. Diuretic-induced hyponatraemia is mostly caused by thiazides; loop diuretics are rarely associated with hyponatraemia4. Selective serotonin reuptake inhibitors (SSRIs), antipsychotics and non-steroidal anti-inflammatory drugs (NSAIDs) are also known to cause hyponatraemia4.
There have also been reports of hyponatraemia following treatment with ACE inhibitors, antibiotics (eg, co-trimoxazole and ciprofloxacin) and proton pump inhibitors4.
Medicines affecting water homeostasis include tricyclic antidepressants (eg, amitriptyline)

THYROID
In 1999 investigations were initated with Dr Simpson of Epsom with regard to thyroid function. “The initial tests showed borderline elevation of the free T4 and a low TSH and low titre antibodies.. The latter were not associated with a corresponding high T3 and were not considered to be necessarily representative of throtoxicosis..The accompanying serological investigations showed a raised rheumatoid factor –with the immunoglobulins, CRP and CSR as normal. There was a suggestion that positive rheumatoid serology and low titre ANF might be suggestive of a connective tissue disorder. An assessment of thyroiditis was made at this time. No further investigations were undertaken at this time”
As a result of a consultation with a haematologist on April 04 further thyroid tests were undertaken resulting in the following results: ‘ Thryoglobulin antibodies Negative (up to 1: 100) // Microsomal antibodies 1:100 ( up to 1:100) – small increase in auto-immune thyroid antibodies.”
Thyroid antibodies are found in 90-100% of cases of thyrotoxicosis. Antibodies are present in less than 20% of cases of non-toxic goiter or thyroid tumour and fewer than 10% or normal persons.
Free T4: 22.0 pmol/l ( 10-24)
TSH 0.004 units/ml (0.4-4.0)
Free T3 5.1 pmol/L (2.5-5.5)
An ultrasound of the thyroid of April 2004 indicated ‘that both thyroid lobes were of normal size. Both showed slight heterogeneity of echotexture Anteriorly in the midpole of the region of the right lobe there was a small hypoechoic nodule of 5 x 3 mm which showed no significant internal vascularity. No other focal abnormality was seen in the right lobe. In the left lobe a smaller 2-3 mm hypoechoic area is also seen. No other focal abnormality detected. The isthmus was normal and no significant lymphadenopathy detected. It was suggested that a follow-up be undertaken with regard to the hypoechoic nodules. Subsequent to examination by Dr Orr-Walker my condition was described as “thyrotoxic with mild resting tremor and tachycardia of 90 /minute/ . The diagnosis also referred to moderate proximal myopathy. There was no dysthyroid eye disease, with normal examination of visual acuity, eye movements and fundoscopy . The thyroid was normal to palpitation with no tenderness nodularity or bruit. There was no lymphadenopathy. The diagnosis was thyrotoxicosis.and carbimazole was prescribed”
In June 2005 Orr Walker described the thyroid as being “minimally enlarged and clinically was not nodular”. There were no bruits”. Treatment with carbamazole was reinstituted in December 05. and I have continued with a daily dose of 10 mgs. On 17 January 2012 Diagnostic Medlab reported “the free T4 as 12.8 and the TSH as 1.4 which are within the normal range.”
In his report dated 19 February2008 Dr Orr Walker advised that “ the thyrioid is only mildly enlarged fleshy with no palpable nodules. I think she would be a satisfactory candidate to proceed to surgery” I advised him that I would be prefer the operation to be undertaken under the public health system however I decided against the procedure.
6 March 2017 Consultation with physician Nicole McGrath of Northland DHB’s Endocrinology Department. Dr McGrath advised “ that my weight was 65 kg heart rate 76 per minute regular and blood pressure 134/75. She appeared clinically euthyroid. The thyroid gland was not palpable. It is most likely that Vickis thyroid nodules are incidental and of no clinical significance however given her obvious concern about this and the fact follow up was recommended I will request a thyroid ultrasound scan. We talked today about thyroidectomy but really if she is tolerating Carbimazole well that seems to be the best treatment for her. I have not arranged to see Vicki again myself in clinic and will leave the follow up to Dr Henderson.”
Thyroid function tests undertaken at Northland Pathology on 25 September 2017 were essentially normal with the exception of the TSH which was assessed “ as borderline low-sometimes temporary recovering from illness-repeat in several months”
Free T4 pmo1/L 13.8 ( Range 10.0-20.0) TSH Miu/L 4.5* (Range 0.30-4.00)
Thyroid Function Tests dated 14 May 18 indicated TSH levels : 4.5* (25/9/18) 7.0* ( 23/3/18 ) 4.2* ( 11/5/18
If on treatment dose /compliance review may be appropriate . A test dated 30 October 2018 indicated a normal TSH of 3.1 consistent with euthyroidism. TSH is again elevated at 4.4 on 6 May 2019. The only abnormality in the thyroid test dated 1a Free T4 reading of 11.00 ( ref range 12.00-22.0 // TSH 2.9 (0.30 – 4.00)
Thyroid function tests undertaken at Northland Pathology on 25 September 2017 were essentially normal with the exception of the TSH which was assessed “ as borderline low-sometimes temporary recovering fIn rom illness-repeat in several months”
TSH Miu/L (Ref range 0.30-4.00)=H 4.525/9/2017 // 7.023/3/2018// 4.211/5/2018// 4.525/9/2018 ////3.1 30/10/2018/ /4.46/5/2019/// 2.9 11/12/2020///4.718/2/2021/// 4.1 mIU (027-4.20) 2/8/2021//////3.0 5/5/2022////23/11/2022 2.0 MiU/L Free T4 MiU/L (ref range 12.0-0-22.0) 13.8 25/9/2017///12.7 23.3.2018//12.5 11/5/2018///12.4 6/5/2019/// 11 /11/12/2020////12.6 2/8/021.
Continued borderline elevation of TSH. If on treatment dose/compliance review may be appropriate .

ORTHAPAEDICS
In 1999 an x-ray ( RADSPEC) of the spine and hip indicated ‘a moderate lumbar roto-scoliosis convex to the left. There was severe intervertebral disc degeneration at L5/Sl.. The other intervertebral articulations appeared well preserved. The sacrociliac joints symphysis pubis and hips were normal . No bony destruction was detected.” A whole spine (chiropractic-Auckland Radiology) undertaken in September 1999 reported “a minor scoliosis of the lower thoracic spine convex to the right and centred at T11/12. There was no underlying cause. In the lumbosacral spine a marked reduction in height was again noted in the L5/Sl disc together with degenerative endplate”.
In November 1999 a left hip ultrasound ( ADHB) was undertaken as a result of extreme discomfort extending down the thigh. “A moderate amount of fluid was noted within the greater tronchanteric bursa on the left with increased blood flow in the peribursal tissues consistent with inflammatory changes and synovitis. The right tronchanteric bursa was normal in appearance without any evidence of inflammation or fluid. No abnormality was identified scanning down the iliotibial band to the knee joint. The diagnosis was significant left greater tronchanteric bursitis.”
A 2003 x ray report( Mercy Radiology) of both feet advised thus: “ Indication of joint pain and swelling – Bone density and alignment are normal. There is no evidence of peri-articular erosions. The joint spaces are well preserved. No underlying bone abnormality is shown.” An enlarged bony growth on the inside of the left foot ( a probable bunion) was however clearly evident but was not reported
In 2006 I appeared to have a broken toe on the right foot. . The end of the toe had suffered a severe blow and was swollen and painful for some months. The female practitioner Dr Henrys recommended that I strap two toes together . She did not examine the toe. According to the American National Institute of Health “buddy taping” of a broken toe is not always appropriate. Neither an x-ray nor a specialist’s visit were suggested. At my instigation an x- ray was requested-and the accompanying report from Auckland Radiology advised “that there was no evidence of any fracture or other abnormality” The radiologist advised “that we are aware that some fractures are not evident on x-ray- MRI scans demonstrate many fractures which are not evident on x-rays alone”
An x ray of the thoracic spine was performed at Greenlane Radiology on 11 May 2011. Findings were as follows: “ there is normal alignment . There are no fractures or destructive osseous lesions. Vertebral body and intervertebral disc heights are maintained. Minor anterior marginal osteophytes are present at T8 and at L2” Quite dense patchy opacities (also cavities??) also seemed to be evident in the x ray but were not referred to in the report.
On 16 August 2012 I suffered a fall down some concrete steps and banged my head on the right side against the adjacent brick wall . The female general practitioner considered that the small haematoma on the head and discomfort on the right side of the head was considered to be better left alone. A CT scan was not deemed appropriate at this time based on my lack of significant symptoms since the accident a week earlier. A skull x ray dated 24 August 2012 ( Auckland Radiology) reported “ No fracture is seen. Alignment is normal. Aeration of the paranasal sinuses is normal’
The scan showed both the rear and front views of the skull with two duplicate images of the left lateral. . Subdural haematomas are always a possibility particularly in the elderly and can develop days or even weeks after after a head injury.
There was also extensive bruising at the base of the spine, the bursa and on the right buttock with accompanying swelling and haematoma .( Haemorraging from the gluteal artery can very occasionally be a concern) . I attended a female general practitioner Dr Anna Thwigg on 24 August 2012 . There was a cursory visual check of the buttock a but no general examination. If there is no reduction in swelling syringing of the area can sometimes be a consideration however the practitioner didn’t seem to be in favour of this course of action. There was no referral for a lumbar scan. I did also develop pain in the left lumbar area extending down the left leg but managed to rectify this with a home massage unit.
Ultrasound of the right buttock . An ultrasound of the right buttock at Auckland Radiology on 24 August 2012 reported:
Indication: “Haematoma secondary to fall on concrete Findings: extensive soft tissue bruising and palpable mass-there is a complex cystic lesion…measuring 78 x 28 x.83 mm with a volume of 96 mls. The mass is 6mm deep overlying the gluteus maximus muscle..no vascularity demonstrated no collection seen in the underlying muscle…..appearance consistent with a large subcutaneous haematoma.”
Much of the severe bruising has disappeared due to the use of hirudoid and arnica creams. An orthopaedic specialist Mr Hucker syringed the haematoma on 14 September however by January 2013 most of the swelling had subsided although there was still some soreness if pressure is applied.
Neurologist Willoughby’s report dated 5 February 2013 advised : “a slightly reduced left knee jerk. The plantars were flexor. Sensation was normal except for mild impairment of vibration in the toes (of no particular significance)”
An x ray of the left knee was performed on 10 September 2014 at NDHB. Findings: “There is mild osteoarthritis of the medial compartment. No fracture or focal bony lesion”
I attended North Shore Hospital’s ED Department with a chest complaint on 6 May 2020. Subsequent to investigation there was“ no leg pain or swelling”
X-ray Knee North Shore Radiology 17 September 2020
No previous imaging available for comparison. Findings: moderate reduction in joint space in the medial compartment with mild changes in the medial aspect of the patellofemoral compartment. The lateral compartment is spared. No joint effusion. Normal alignment. No fracture.
Radiologist: Nina Umaria
An ultrasound of the left shoulder and arm was performed at TRG Radiology on 29 September 2020
SHOULDER (LEFT) ULTRASOUND INDICATION Pain going down the arm particularly when reaching back
FINDINGS Long head of biceps: Intact. Subscapularis: Intact.Supraspinatus: Intact. There is a moderate insertional enthesopathy posteriorly. Infraspinatus: Intact Teres minor: Normal Suprascapuar notch and spinogienoid notch: Normal.osterior glenohumeral joint: Normal./////////Acromioctavicular joint:There is capsular thickening. on-tender to probe guided compression,Coracoacromial ligament:Normal. Subdeltoid bursa and dynamic imaging: //////// Bursa:Mildly thickened.Dynamic imaging: There is a painful arc commencing at 120 degrees There is mild bursal bunching during abduction.
CONCLUSION: Borderline thickening of the subacromiail bursa raises the possibility of early bursitis. if clinically’ relevant an ultrasound guided steroid injection can be offered. * No high-grade rotator cuff-tear detected.
Dr Franco:s Du Toit, Radiologist //////Tracie Phillips Sonographer////TRG Imaging///// INDICATION Painful left arm and shoulder.
FINDINGS Mild sclerosis of the greater tuberosity No soft tissue mineralisation. Glenohumeral and AC joint is congruent.No destructive bony lesions. Partially
Included chest is clear
Thoracic and Lumbar x-rays were performed at North Shore hospital on 7 November 2022.
Thoracic: Vertebral alignment is maintained. There is a mild multilevel degenerative change of the thoracic spine. No vertebral body wedge fracture.
Lumbar spine erect: Vertebral alignment is maintained. There is degenerative change throughut the visualised spine. This is most marked at the L1/L2 level. Mild scoliosis convex to the left. Appearances have not significantly progressed since the previous film.Radiologist: Luke Wheeler

GYNAECOLOGY
In 1988 I attended a well-known female gynaecologist Dr Liggins who, subsequent to examination, advised that there was nothing significantly amiss.. I had suffered years of pain. At the sole instigation of my own General Practitioner Dr Harries an ultrasound was performed and a large uterine fibroid was discovered.8 showed a “large well-defined mass of around 8 cms in diameter with slightly heterogeneous echo texture. It appeared to arising in the right side of the uterus and was considered to be a large uterine fibroid. Both ovaries appeared normal. No free fluid was shown in the pelvis and the bladder appeared normal”.
Subsequent surgery in May 1988 by Dr Liam Wright at Mercy Hospital Auckland resulted in “a laparotomy which revealed a large fundal fibroid and a smaller one in the anterior wall. The right ovary was quite densely adherent to the back of the uterus with endemetriosi and there was a small endometriotic cyst. The left ovary was normal except for 2 tiny black dots. The latter may have been endometriotic or were perhaps the site of previous follicles. They were treated with diathermy. The remainder of the abdomen and pelvis were normal to palpitation. A total hysterectomy and right salpingo oophorectomy were performed. There were no complications.”
Comments on the Asian shortwave indicated that an object ( unspecified) had been discovered during the course of the surgery. While waiting in the lobby at Ascot Hospital on a subsequent occasion I overheard 2 comments from 2 male staff members -the one unknown -“ The Director of this hospital doesn’t like you visiting here” and the other a comment from Dr Richard Fisher of Fertility Associates and Ascot Hospital -“ you like cats”. I had purchased a toy cat from the chemist in the foyer. Whether there is any connection between these 2 incidents has yet to be determined.
In 1991 I experienced severe pain and contractions in the groin area in both the left and right sides after severe exertion. . I subsequently was admitted to day surgery for an E.U.A. and diagnostic laparoscopy performed by Professor Ron Jones–the report stated “limited E.U.A. failed to reveal any abnormalities. The left ovary appeared normal –and there was a a loop of small bowel adherent to the stump of the right ifundibulo pelvic ligament . There was no evidence of an obstructive element .” I was reassured by the nurse that I might experience a little pain after the procedure however I experienced very severe pain extending from the groin to the shoulders over a period of months! The gynaecologist jokingly commented that “ he had trampled over my insides with his boots on”!
A pelvic ultrasound was undertaken in April 2003. . “The left ovary was described as being of normal size with a volume of 8.3 cc. Arising from the ovary was a small oval unilocular simple cyst ( 2.4 x 1.4 x1.3/2.3 cc). There were considered to be no significant findings nor there was any mass lesion or free fluid identified elsewhere in the pelvis.” A subsequent scan of 15 February 2005. performed at Green Lane Radiology from advised “the left ovary was visualized and measured 19mm x 19mm x 15mm giving a volume of 3cc No ovarian cysts were evident. There was a large amount of adjacent fluid-filled bowel. No free fluid . There was no evidence of any cysts”
Tests undertaken in Jan 02 for LH FSH Oestraadiol and progesterone ( Post –menopausal) all seemed to be within the normal limits. A carcino-Embryonic Antigen test in April 03 also seemed to be within the normal range at 0.6 ( range 0-3.0)
A pelvic ultrasound was performed at Ascot Radiology on 22 March 2012. Findings:……… “Surgical abscence of the uterus is noted Neither ovary is identified and no mass or free fluid is detected. The kidneys are of normal size shape position and echotexture. The right kidney is 10.2 cm in length the left kidney at 10.8. Summary: Appearances are within normal limits with no sinister pathology.” The radiographer was of the opinion that an alternative type of pelvic ultrasound might have been more appropriate in respect of visualising the remaining left ovary however ultrasound scanning of the left ovary in 2003 was apparently achieved without any difficulty.
MAMMOGRAPHY:
I have a 30 year history of breast fibroadenomas beginning in 1973 with the removal of an “ intra canalicular fibroadenoma in the right breast” in the USA. In November 1985 another fibroadenoma was removed from the right breast at Wellington Hospital – “ an irregularly nodular smooth surfaced lump of grey/white tissue measuring 1.6 1.5 x 1cm –sections show a fibroadenoma of intracanalicular type. Several foci of aprocrine metaplasia are present within the adenoma. A small amount of adjacent breast tissue shows fibroadenosis”. An Auckland Hospital Histopathology report dated 3 July 1997 concerning a fibroadeoma in the left breast reported ‘the mammogram suspicious” I was not aware of that diagnosis until approximately a year later when I managed to obtain a copy of the report.
The same fibroadenoma measuring 30 x 28x 24 mm was removed from the left breast at Auckland Hospital by surgeons (Hamil and MacCormick) on 3 July . It was described as “ a circumscribed and lobulated mass 30’ x 28’x 24’with a small amount of attached fatty tissue. The cut surface is firm and yellowish grey with small foci of haemorrhage…..there is no atypia or malignancy” (foci of haemorrhage and necrosis are sometimes associated with malignant Phyllodes tumour). In 2003 a large cyst measuring 11 mm in the left breast was aspirated and produced 2 mls of yellowish fluid. In 2004 2 fibroadenomas were diagnosed in the left breast one measuring 10 mm and the other 5 mm. A solid isoechoic mass measuring 5 mm was also diagnosed in the right breast.
24 October 2002 a breast ultrasound was performed by Margaret Adams of Mercy Radiology:“In the right breast in the 6 o’clock position just below the nipple there was a reasonably well defined mass of homogeneous low echogenicity with some posterior shadowing measuring 5 x 7 mm which was consistent with a small adenoma. In the 11 o’clock postion and adjacent to the nipple there was a small cystic mass ( 5 x 5 mm) with some internal echoes but through transmission.i.e. a small cyst. In the left breast there was a cyst measuring ( 14 x 10 x 14.5 mm )which was well defined –had good through transmission but contained internal echoes. This was in the 12 o’clock position again adjacent to the nipple. There were smaller areas of uniform echogenicity with well defined borders and poor through transmission one measuring (8 x 10 x 3 mm) and a small mass with identical characteristics measuring (6 mm. ) The latter were consistent with small fibroadenomas. There was recommendation of confirmation of benign histology by biopsy.”
Ultrasound of the breasts at the Mercy Breast Clinic in April 2003 showed “ a (3-4 mm )rounded cyst at the 11 o’clock position in the right breast. In the 6 o’clock position there was an ovoid (5 mm) hypoechoic lesion possibly commensurate with a small cyst or adenoma. On the left side there was a cyst in the the 2 o’clock position measuring about( 11 mm) in diameter. This was considered to be smaller than an earlier measurement. The remainder of the breast looked normal to ultrasound review.A resulting aspiration of the large cyst in the 2 o’clock position on the left side resulted in a couple of mls of yellowish fluid. The lab report indicated a number of foamy histiocytes and lymphocytes consistent with a benign breast cyst”’
A mammogram and ultrasound were performed at Auckland Hospital in September 2003. “A small well defined lesion in the right breast just below the areola was described as unchanged as well as the 2nd adenoma. A small nodular lesion in the left outer breast was in keeping with a small intramammary lymph node. In the right breast there a small oval isocheoic lesion at 6 o’clock .measuring 7 mm in size . 2 small cysts were noted at 11 12 o’clock measuring 4mm and 2mm in size. Ultrasound of the left breast showed small cysts at 12 o’clock measuring 32mm and 4 mm respectively. 2 small ovoid lesions are seen at 12 o’clock deep to the areola measuring 6 and l0 mm.” There was considered to be no significant interval change-2 yearly mammography was recommended.
A bilateral breast ultrasound : Auckland Hospital on 14 October 2004 reported thus: “ In the left breast just superior to the nipple there is an ovoid 10 x 3 x 7mm solid benign appearing mass with a thin echogenic capsule and posterior through transmission. Just to the right of this is a second solid lesion with similar characteristics which measures 5 x 2 mm . Also in the left breast around 11-12 o’clock there are two tiny cysts each measuring 3mm. In the right breast there s a solid isoechoic mass at the 6 o’clock position a couple of centimetres inferior to the nipple. This is difficult to discern from the surrounding tissue as it is isoechoic to the adjacent fat. It measures 5 x 4 x 5 mm. In addition two 3 mm cysts are noted in the upper outer quadrant of the right breast”
I have previously had a lengthy discussion with Dr Ng of the Greenlane Breast Clinic concerning the removal of breast adenomas. He advised that if they keep increasing in size then biopsy might be considered. The NIH(National Institute of Health) USA advises “ that most surgeons prefer to remove fibroadenomas to make sure they are benign. Excisional biopsy which is similar to lumpectomy is currently the standard procedure for lumps that are smaller than an inch or so in diameter. Not every lump merits a biopsy –however, regardless of the fact that benign lumps rarely turn into cancer, cancerous lumps can develop near benign lumps and can be hidden on a mammogram. Even if you have had a benign lump removed in the past it cannot be assumed that any new lump would also be benign”
A breast ultrasound: Auckland Radiology in Kepa Road Mission Bay on.4 June 2009. During the course of the scan I advised the radiographer that I had inadvertently omitted to bring copies of the previous ultrasound reports and film. I did advise her that the most recent ultrasound was performed at Auckland Hospital in 2004 and I could email the report to Radiologist Ms Peart if necessary. However in her report dated 4 June 2009 radiologist Ms Peart advised “that previous mammograms from 2003 and 2005 and ultrasounds from 2003 and 2004 are available for comparison. There are no reports”
The only reported finding was “a single 7 x 2 x 6 mm well circumscribed ovoid focal lesion in the right breast which has appearances most in keeping with a small intramammary lymph node.–no other focal or cystic sonographic abnormality is identified in either breast.
This fibroadenoma of approximately 5 mm was previously identified in a Mercy Radiology’ report of 24 October 2002 together with “two smaller areas of uniform echogenicity measuring 8 x 10 x 3 mm and 6 mm respectively with well defined borders and poor through transmission ….consistent with small fibroadenoma”. These findings were further confirmed in an ultrasound report from Auckland hospital dated 14 October 2004-the 2 fibroadenomas in the left breast were described as having “posterior through transmission”
In recent years the only surgical procedures have involved a 3cm fibroadenoma which was surgically removed at Auckland Hospital in 1997 and a large breast cyst was drained at the Mercy Breast Clinic in April 2003 by Mr Cotter. I requested an explanation from Ms Peart as to the significant non-reporting of fibroadenomas in the left breast. Ms Peart advised “ that the sonographer did relay to me that you had previous breast cysts and fibroadenaomas with surgery for these and that she had looked very carefully for any solid lesions and failed to identify any other than those described above. ‘She also advised me that you had offered to make the reports of the previous imaging available to us. However as no sonographic features of any concern had been seen I felt that this was unnecessary. With respect to the significant non reporting of fibroadenomas …..in the left breast these were not visualized on this study and therefore I could not describe them in the report . There are two likely reasons that we did not identify on ultrasound as they are very mobile and often move away from the transducer. Thus it is possible that they remain there but we did not visualize them as presumably happened in the ultrasound in 2003. However fibroadenomas also involute over time and they may have decreased significantly in size or resolved completely since the most recent previous scan in 2004”.
Previous ultrasound scans of 2002-2004 did not encounter any of these difficulties with regard to “visualizing”of fibroadenomas. The ultrasound report of the Mercy Breast Clinic dated 24 April 2003 reported “ on the left side there is a cyst in the 2 o’clock position measuring about 11 mm in diameter. The additional annotation that “The remainder of the left breast looked normal to ultrasound review” omitted any reference to the fibroadenomas. Bearing in mind that the reported “visualised” fibroadenoma in the right breast had actually increased in size, the likelihood of the fibroadenomas having disappeared from the left breast is very remote. Diagnostic descriptions of fibroadenomas in the left breast have ranged from “a suspicious mammogram, to poor and posterior through transmission”. The reason provided concerning the ability of the fibroadenomas to move away from the transducer seems rather dubious. The blatant failure to scan fibroadenomas is nothing short of negligence and is further compounded by the fact that clarification by way of a further investigative scan was not requested by the radiologist. It also raises questions as to whether similar failures have occurred in respect of other types of scans (e.g. CT scans of the lungs).
A recent bilateral breast ultrasound undertaken by the Horizon radiology group in August 2010 reported “ no fibroadenomas seen and multiple small cysts seen throughout both breasts” !
I consulted with the Director of both Radiology and the Breast Clinic at public hospital on 3 February 2011 subsequent to A bilateral mammogram and breast ultrasound was performed at public hospital in February 2011. The consultant was Dr Ng.
.The report of February 2011 is as follows: ‘Findings: bilateral mammograms are stable in appearance with symmetrical mildly dense breast parenchyma with no suspicious masses microcalcifications or distortion. The bilateral benign appearing masses are unaltered in size and number. In the right breast the benign appearing 6 o’clock mass remains stable measuring 4 x 5 mm (previously 4 mm). No internal vascularity demonstrated. In the left breast the 12 o’clock benign appearing mass measures 11 x 3 x 8 mm( previously 10 x 6 mm). No internal vascularity. A 5 mm ovoid anechoic cyst is noted more superiorly. Interpretation: stable mammographic and ultrasonographic appearances of the bilateral benign masses. No evidence of malignancy.” This report omitted to mention a second solid lesion which measured 5 x 2 mm in 2004 also located in the left breast.
I later discussed the possibility of obtaining a dvd/cd of the scan with the receptionist who rather belligerently demanded to know why I would want it and what I intended to do with it !
In 2011 it was agreed to surgically remove the fibroadenomas at public hospital in the near future depending on my health. In the interim my latest chest x ray was also requested. I discussed the matter of the disparity between the lack of diagnosis of fibroadenomas in the breast ultrasounds by two alternative private radiology groups in comparison with the findings of both public hospital and one other radiology group. I expressed my concern that it could have wider implications for other patients. . Dr Ng demurred and felt it was not within his jurisdiction to pursue the matter further unless perhaps a cancer was involved. He suggested that I take the matter up personally with the Directors of the other Radiology groups. The surgical removal of fibroadenomas had been delayed pending the completion of the course of antiplatelet clopidogrel medication prescribed after arterial stenting. A further consultation at public hospital is scheduled for February 2013.
On 11 August 2011 Surgeon Dr Puttick advised my former General Practitioner Dr Retford : “Your patient was unable to attend a follow-up appointment in the Breast Clinic today. From reviewing her notes she is on the list to have some breast lumps removed, but in the interim she has had some cardiac issues and is awaiting coronary artery bypass grafting. This is obviously more pressing that the breast problem and we would not proceed with general anaesthetic for a breast problem without the cardiac issues being sorted out first. We will send her an appointment to see us in six months’ time when hopefully things will be looking a bit better. I also note that she is seeing the dermatologists about some skin lesions and we could discuss these with her if she still wishes to have them excised, perhaps at the same time as her breast lumps, as we do quite a lot of skin surgery.
Kind regards .Yours sincerely Mr Michael Puttick MBBS MD FRCS (General Surgery)Breast and Endocrine Fellow to Messrs. Jones, Cranshaw, Ng & Prof. Shaw 021842940 . I did not take up Mr Putticks offer as I was awaitng heart stenting procedures .
A bilateral mammogram and ultrasound were again performed at public hospital on 15 March 2012. Findings: “ comparison is made with previous mammogams of 2/11. There is no significant interval change. The breasts are of mixed density A small benign appearing nodule in the central right breast is stable . Other benign appearing densities mostly skin lesions are also stable. No new focal masses, areas of architectural distortion or suspicious microcalcifications are detected. Bilateral ultrasound shows two small benign appearing masses in the left breast close to the nipple at 12 o’clock . These are a few mm apart from each other and measure 9 x9 x3 mm ( previously 11 x 8x 3 mm) and 5 x 4 x 2 mm ( previously not perceived ). No other left breast abnormality is seen-the small cyst noted last year is not evident. In the right breast the lesion at 6-7 o’clock near to the nipple is stable at 5 x 4 x 4 mm ( unchanged). Another subtle mass at 11 o’clock measuring 5 x 3 x 3 mm is also likely to be a small fibroadenaoma and is benign in appearance. No other abnormality is seen.
CONCLUSION: No evidence of malignancy. The two lesions seen last year are stable. The Mammogram is stable. A further lesion in each breast is seen today neither of concern-scans from year to year will vary due to different sonographic technique.”
I visited the breast clinic at Greenlane clinical centre on 25 february 2013. I was first appraised by a young Asian female registrar who also performed a breast examination She had Dr Ng’s report dated 22 March 2012 in which he advised “ that if she wishes to proceed with surgery then she can be assessed by the anaesthetists”. Surgery had initially been delayed until I had completed a course of clopidogrel medication prescribed after a stenting procedure in late 2011.
The registrar however did not have the Radiology report dated 15 March 2012-I provided her with a copy!. She was unable to detect any fibroadenomas and there was no discomfort during the examination. A further examination was performed by an Indian specialist which caused quite severe discomfort and the the obvious “tenderness” was noted. I have now been rescheduled for surgery in the near future.
A referral was made to the Breast Clinic Whangarei in 2014 by Dr Henderson of Onerahi however apart from a phone call from a nurse querying whether I retained any reports a consultation never eventuated.
Subsequent to a referral from Dr Henderson to the Breast clinic at Whangarei hospital a reply was received from Dr Usha Shan breast surgeon: “ I appreciate this is a very difficult situation for you. I have discussed with the breast team including colleagues involved in screening and diagnostic services. We have reviewed your referral and the Auckland clinic letter from Mr Ng and the consensus is that there is no indication for her to be seen in the breast clinic. We have lack of resources, no capacity and a long waiting list for symptomatic patients. It is very common to find incidental fibroadeonomas ( no palpable) on screening mammograms. The standard treatment for non-palpable fibroadenomas is for observation and this is done at the time of 2 yearly mammogram via free breast screening program. She had the option of seeing a private surgeon.”
A mammogram was performed at Mauri Ora mammography on 17 January 2017. . A report from Dr Jenny Walker clinical Director of Breast Screen Wiatemata Northland advised “ No evidence of cancer.” In one frame a small bright line extends under the breast . When it is magnified a dense cotton wool type of infiltrate/opacity is depicted in the chest wall possibly extending into the breast.
On 8 June 2017 NDHB radiologist Dr Dawber advised “ I am unable to comment on the Mercy Radiology MRI and the Mauri Ora Breast Screen mammogram and would advise you to contact them if you require any further information” On 4 July 2017 Director of Waitemata DHBs respiratory clinic Dr Cornere advised: “ I am sorry I can’t be more helpful but I have absolutely no experience in interpreting mammography Hopefully you will get a reply from the radiologist and breast physician who should be able to assist as they have the expertise.” As at 8 April 2018 I have not received any clarification.
An email requesting further advice with accompanying images was sent to Breast surgeon Dr Shan on 8 June 2017 but there was no reply from either Shan or radiologist Dr Shepherd of Mauri Ora mammography .
Ms Susan GERRED General Surgery Waitemata DHB///Copy To GP Dr Audrey Thorpe//Re. WILSON, Vicki NHI: GRD8664 DOB :02/07/1949
Exam performed at: North Shore Hospital Radiology Date of exam: 21/07/2020 Examination (s) included in this report: Mammogram Clinical Bilateral US Breast INDICATION: For follow—up of previous for breast fibroadenoma
FINDINGS : Comparison is made with previous mammograms of at 2019 and 2012. There is no significant interval change. Stable small bilateral benign appearing nodular densities. No spiculate masses, areas of architectural distortion or suspicious microcalcifications are detected. Correlation made with the breast ultrasound 15/03/2012. In the right breast a well—defined hypoechoic nodule at 7 0’clock near the nipple measuring 6 x 2 mm. No further lesions identified in the right breast. ( The breast ultrasound of 2012 reported “In the right breast there is another subtle mass at 11 o’clock measuring 5 x 3 x 3 mm is also likely to be a small fibroadenaoma and is benign in appearance”)
In the left breast are two benign appearing nodules at 12 0’clock near the nipple measuring 10 x 2 mm and 5 x 2 mm. No other lesions in the left breast. Normal axillae bilaterally. COMMENT: No features suspicious for malignancy . Stable bilateral benign lesions which have the appearance of fibroadenomas .
DOUBLE READ BY: Dr C Paulus Kim WILLIAMS Radiology Consultant Report status: Validated.
There are two ( undiagnosed) smoky black irregularly shaped images of varying size with shadowing?in the scan which may be synonymous with spiculated masses?). A second opinion was requested but the the patient service centre of Waitemata DHB advised on 24 July and 12 August 2020” that you have undergone a triaging process that included an assessment of the referral by a Breast Surgeon . Your breast imaging investigations showed no abnormality and you are not required to attend a clinic appointment.-unfortunately the assessment of your clinical details did not meet the criteria for an outpatient assessment appointment with the specialist.”
On 5 November I emailed copies of the breast scan to Dr Karen Amies oncologist at ADHB, and brea surgeons Dr Mitlick and Mr Harman for an opinion. There has been no reply. On 27 I emailed The Quality Team at Waitemata DHB.
Dr Gerred Breast Surgeon telephoned me in early December to advise that the black images in the scan were “fat”! and followed up the phone call with a letter dated 3 December 2020
Problems: “Reassurance regarding breast imaging. It was good to talk to you today regarding your feedback that you submitted to Waitemata District Health Board regarding your breast imaging. You underwent mammogram and USS on 21/07/2020. Today, I was able to reassure you that your imaging did not show anything of concern and that there were no spiculated masses which you were concerned about. I went through that fat appears black on mammograms and glandular tissue white.? I have had yours reviewed by our Head of Breast Radiology who has reviewed the films from 2019 and 2012 as well and there are no changes. You were quite aware that you have the fibroadenomas that have been stable for years. I reassured you today that this was all good news and there is nothing here that needs any further follow up or imaging.
Electronically sighted and approved by Mrs Susan Gerred General & Breast Surgeon
Although the appearance of fat in mammograms is a description which normally equates with the condition “ fat necrosis” Gerred did not specifically refer to the ultrasound images. The images of fat necrosis in ultrasound seem to differ from the images in my ultrasound insofar as they tend to be generally rounded /oval in shape. Dr Thorpe agreed to seek a further opinion of Breast Surgeon Mr Harman. As of 15 December 2020 no alternative opinion has been provided.
Dr Thorpe agreed to seek a further opinion from Breast Surgeon Mr Harman however it appears that a reply has not been received by the general practitioner either. Dr Gale was emailed a query but there was no reply. Instead Helen Olsen operations manager General Surgery advised:
Hi Vicki: Thank you for your email asking for an opinion on your breast imaging. We supplied a second opinion in December last year and are unable to provide another one.
If you have any concerns please don’t hesitate to follow up with your GP, or contact the Advocacy service or the Health and Disability Helen Olsen| Operations Manager | General Surgery |Waitemata District Health Board
Another bilateral l breast ultrasound was performed at the Auckland Breast Clinic on 27 May 2021
Concern about ultrasound image of the left breast. Known presumed fibroadenomas in both breasts. The mammograms and breast ultrasound examination performed at North Shore Hospital on 21/07/2020 are available for review.
FINDINGS
Ultrasound examination of both breasts was performed. In the right breast 7 0’clock position, there is a circumscribed hypoechoic solid nodule measuring 5 x 2 mm (previously 6 x 2 mm). In the left breast 12 0’clock position, there are two adjacent similar appearing circumscribed hypoechoic solid nodules measuring 8 x 2 mm (previously 10 x 2 mm) and 5 x 2 mm (previously 5 x 2 mm). No solid or complex cyst is identified elsewhere in either breast. Both axillae are normal with no lymphadenopathy.
CONCLUSION
nipple seen on the North shore Hospital breast ultrasound dated 21/7/20 is normal posterior acoustic shadowing caused by the nipple
Dr Mike Baker,Radiology Auckland Breast Centre
The large dense black variegated image arising from the nipple in the ultrasound of 2020 is no longer evident in the latest scan of May 2021. The Journal of ultrasound in medicine advises “ Although posterior acoustic shadowing is a sonographic feature that is most commonly associated with mammary malignancies, this sonographic finding may also be seen with benign breast lesions. An enlarged lymph node was evident in the ultrasound of 2020 but not in the scan performed at the Auckland Breast Centre in 2021. It was not diagnosed in either scan. Since 2004 the largest of the fibroadenomas in the left breast has changed from 10 x 3 x7 mm in 2004////11 x 3 x 8 mm in February 2011//////10 x 2 mm July 2020 /////////8 x 2 May 2021
There is a significant difference in the procedures at the breast clinics of both ADHB and Waitemata DHB. When I previously attended at ADHB, subsequent to scanning the patient would then wait in a private room for a consultation with the attending specialist. Unfortunately subsequent to scanning, Waitemata DHB despatches a letter advising patients that they do not fulfil the criteria for a consultation with a breast specialist. The last breast examination was at ADHB in 2012.
HAEMATOLOGY
1988 I was diagnosed with Myalgic Encephalomyelitis by Dr Simpson of Dunedin. A blood test clearly esablished “ an increase in the cup forms together with an abnormal increase in the surface changes of the cells”. Simpson also referred to “surface changes” (bumps and ridges). While he has listed echinocytes and knizocytes it isn’t entirely clear whether they have also been incorporated into his assessment as there is no specific percentage measurement for either.
Echinocyte (from the Greek word echinos, meaning ‘hedgehog’ or ‘sea urchin’), in human biology and medicine, refers to a formof red blood cell that has an abnormal cell membrane characterized by many small, evenly spaced thorny projections.[] A more common term for these cells is burr cells. Echinocytosis is a reversible conditin of red blood cells that is often merely an artifact produced by EDTA, which is used as an anticoagulant in dried blood.
In addition to appearing as an artifact of staining or drying, echinocytes are associated with
Uremia and chronic kidney disease/////Liver disease (e.g., cirrhosis)// /hypophosphatemia//hyperlipidemia/Phosphoglycerate kinase deficiency//Disseminated malignancy//Myeloproliferative disorders//Vitamin E deficiency//Early posttransfusion of RBC
The term knizocyte describes a specific shape form of erythrocytes that deviates from the standard form. … Like normal red blood cells, knizocytes show a clear central area, but this is crossed by a thin strip of hemoglobin. It can be seen particularly in patients with thalassemia.
Thalassemias are inherited blood disorders characterized by abnormal hemoglobin production.[7] Symptoms depend on the type and can vary from none to severe.[1] Often there is mild to severe anemia (low red blood cells).[1] Anemia can result in feeling tired and pale skin.[1] There may also be bone problems, an enlarged spleen, yellowish skin, and dark urine.[1] Slow growth may occur in children.[1]
Thalassemias are genetic disorders inherited from a person’s parents.[2] There are two main types, alpha thalassemia and beta thalassemia.[7] The severity of alpha and beta thalassemia depends on how many of the four genes for alpha globin or two genes for beta globin are missing.[2] Diagnosis is typically by blood tests including a complete blood count, special hemoglobin tests, and genetic tests.[3] Diagnosis may occur before birth through prenatal testing.[8]
As of 2013, thalassemia occurs in about 280 million people, with about 439,000 having severe disease.[9] It is most common among people of Italian, Greek, Middle Eastern, South Asian, and African descent.[7] Males and females have similar rates of disease.[10] It resulted in 16,800 deaths in 2015, down from 36,000 deaths in 1990.[6 Those who have minor degrees of thalassemia, similar to those with sickle-cell trait, have some protection against malaria, explaining why they are more common in regions of the world where malaria exists.[12]’
In 2004 I attended a haematologist( Dr Blacklock) as my haemoglobin level had declined from 145 in 2003 to 118 . While the neutrophils were classified as marginal there was no reference to the missing RBCs. There was considered to be no significant anaemia and it was suggested that further investigations should concentrate on the lung and thyroid. As a consequence I am now also being treated for hyperthyroidism or Graves disease.
In 2005 I received written advice from the Medlab Director Dr Theakston as to why my red blood cells hadn’t been reported for 7 years .i.e. “reporting of this value had been discontinued as general practitioners did not think it provided any useful additional information to the haemoglobin concentration” As haemoglobin is a component of RBCs one would assume that an assessment of both would be necessary. Size/shape of RBCs can be important in ME as can the number of RBCs. Excessive numbers can lead to thickening of the blood and clotting. According to NIH (American National Institute of Health) RBCs are still being reported in every blood test. In 2008 Theakston further advised that non-reporting of the red blood cell count was general practice in most New Zealand medical laboratories however a blood test undertaken by Labplus in September 2008 reported the RBC count as within the normal range .
The blood count , the serum B12 and Folate, also the iron studies tests performed at Northland pathology on 25 September 2017, were within the normal range. Labtests dated 2 August 2022 -B12 and folate were normal.
A full blood Count as part of a panel at NDHB’s laboratory dated 2 August 2018 indicated a high count of Immature Granulocytes 0-10 E+9/L H 0.0-06.
Healthline explains “that granulocytosis happens when there are too many granulocytes in the blood. Granulocytes are a type of white blood cells that seems to contain small granules when examined under a microscope. These tiny granules have proteins essential for immune system function.
Some of the health problems associated with granulocytosis include leukemia, inflammatory bowel diseases, bacterial infections, sepsis, metastatic cancer, kidney failure, rheumatoid arthritis, heart attack and autoimmune disorders. Additionally, burn injuries, habitual smoking, physical and mental stress, as well as usage of medications such as corticosteroids may also result in high levels of granulocytes”
A blood count from Northland Pathology indicated a normal blood count. Since February 2019 lymphocytes have varied from 1.5-1.8 to 1.6 (ref range 1.0-4.0) “ Blood film examined -no immature granulocytes seen. Increased oval cells. Platelets appear normal”
Wikepedia advises: “Elliptocytes, also known as ovalocytes, are abnormally shaped red blood cells that appear oval or elongated, from slightly egg-shaped to rod or pencil forms. Rare elliptocytes (less than 1%) on a peripheral blood smear are a normal finding. These abnormal red blood cells are seen in higher numbers in the blood films of patients with blood disorders such as:[2Thalassemias: Iron deficiency Myelodysplastic ndrome and myelofibrosis Primary myelofibrosis is a relatively rare “bone marrow/blood cancer” .[1] It is currently classified as a myeloproliferative neoplasm, in which the proliferation of an abnormal clone of hematopoietic stem cells in the bone marrow and other sites results in fibrosis, or the replacement of the marrow with scar tissue.
Megaloblastic anemia is an anemia (of macrocytic classification) that results from inhibition of DNA synthesis during red blood cell production.[1] When DNA synthesis is impaired, the cell cycle cannot progress from the G2 growth stage to the mitosis (M) stage. This leads to contivision, which presents as macrocytosis.”
As I was afflicted with a chest complaint I attended the ED Department at North Shore Hospital on 6 May 2020. I was attended by Dr Etienne De Beer -Senior Medical Officer. Both a blood test and a general chemistry test were undertaken. The blood test was normal with the exception of the lymphocyte levels : 0.7 xE9/L range (1.0-4.0 x E9/L) L. General chemistry results were normal
A blood test dated 18 February 2021 was essentially normal apart from : WBC 12.4 x10e9/L (4.0-11)H, – Neutrophils 9.0 x10e9/L (1 .9-7.5)H -Monocytes x 10e9/L (0.2-1.0) H
A full blood count dated 2 August 2021 was normal with the exception of Haemoglobin 113/g/L ( 115-155 L//////HCT 0.35 L/L (0.35-0.46)/////////11 November 2021: normal with the exception of Haemoglobin 114 g/L (L) and HCT:0.34 L/(L)
The complete blood count performed at Labtets dated 16 February 2022 was normal with the exception of Hematocrit -0.34 ( 0.35-0.46). A test at the Waitemata Hospital Laboratory dated 26 March 2022 reported Haematocrit as 0.34 L (0.36-0.46. and Neutrophils as 7.9 E9/L H (1.97.5 The lymphocytes were at the lower end of the normal range at 1.0 x E9xL (1.0-4.0) The Labtest dated 5 May 2022 indicated all tests were in the normal range. HCT was 0.36 (0.35-0.46 and haemoglobin was 119 (115-155)////Labtests CBC dated 2 August 2022 was normal as was the test dated 23 November 2022. Both the lymphocytes 1 2 x10e9/L ( 1.0 – 4.0) and the Eosinophils:0.1 x10e9/L ( < 0.6 ) were low but within the normal range.
Low Hgb is also known as anemia, which means that you don’t have enough red blood cells in your body. With anemia, a blood test will also show that you have a low red blood cell count and may have low hematocrit, the volume of red blood cells to other components in your blood. Cleveland clinic recommends iron treatment. Webmd advises here are more than 400 types of anemia, and they’re divided into three groups: Anemia caused by blood loss///Anemia caused by decreased or faulty red blood cell production//Anemia caused by destruction of red blood cells
Cleveland Clinic advises:: “Neutrophilia, also known as neutrophilic leukocytosis, occurs when your neutrophil count is too high, which is often the result of a bacterial infection. To combat the infection, immature neutrophils leave your bone marrow too soon and enter into your bloodstream.
What causes a high neutrophil count?
In many cases, it’s normal for your body to produce more neutrophils to help you heal, especially in the case of a bone fracture or severe burn. When the number of neutrophils doesn’t decrease to normal levels after repairing an injury, it can pose a health risk. The number of neutrophils in your body may increase due to: Infections Inflammation, Injury, Certain types of leukemia, Reactions to certain drugs.”
Ferritin 210 ( 2/8/2021///// 97 ( 5/5/2022) (20-380)///Labtests 2 August 2022////Prothrombin time (the time it takes for blood to clot) 10.0 secs (9.//0-14.0)//////INR: (used to monitor blood thinning anticoagulants) 0.9 (0.8-1.2)//////A.P.T.T.(coagulation test to see how long it takes for blood to clot)////Fibrinogen: assesses likelihood of getting a blood clot) 4.5 g/L (1.5-4.0) H
A CBC was performed at Waitemata DHB on 31 March 2023. All the tests were normal including the lymphocytes @ 1.1 x E9/L( 1.0-4.0) low but within the normal range

Immunoglobulins were assessed at North shore hospital on 31/3/2023: IgG 10.1 g/L( 6.0-15.0)/////////IgA 0.8 g/L ( 0.8-4.0)///////IgM 1.2 /g/L (0.4-2.4) The Total serum IgE was 9 kIU/L( 0-100) Low serum IgE has been associated clinically with chronic fatigue and polyarthralgias 8 and a higher prevalence of autoimmune and oncological diseases and asthma, as well as chronic sinusitis and otitis media

Medline Plus advises: IgM antibodies are the first immunoglobulins your body makes after you’re exposed to germs. They provide short-term protec-tion while your body makes other antibodies. IgM antibodies are in your blood and lymph fluid (a watery fluid that carries the cells that fight infections and diseases to all parts of your body).
IgG antibodies are very important for fighting infections from bacteria and viruses. Most of the immunoglobulins in your blood are IgG. You also have some IgG antibodies in all your body fluids. Your body keeps a “blueprint” of all the IgG antibodies you have made. That way, if you’re exposed to the same germs again, your immune system can quickly make more antibodies.
IgA antibodies protect your respiratory tract (the organs you use to breathe) and your digestive system (the organs you use to eat and digest food) from infections. You have IgA antibodies in your blood, saliva, and gastric “juices.”
An immunoglobulins blood test measures the amounts of IgM, IgG, and IgA in your blood to help diagnose different types of health conditions that may affect your immune system.
An immunoglobulins blood test may be used to: Check the health of your immune system if you are often sick with infections or diarrhea///////Help diagnose and monitor a variety of conditions that may cause abnormal levels of IgM, IgG, and/or IgA, such as :Autoimmune disorders. With these disorders your immune system attacks your own healthy cells by mistake, including cells that make immunoglobulins. Examples of autoimmune disor-ders include rheumatoid arthritis and lupus./////////////Certain types of cancer that affect your bone marrow, blood, or immune system/////////Chronic (long-term)infections /////////Genetic diseases you’re born with (uncommon)
Aspergillus 0 class <0.05 KIU (A) L Aspergillosis is an acute pulmonary infection caused by the aspergillus fungus. Aspergillus can cause illness three ways an allergic reaction in asthmatics, a colonization in scarred lung tissue, and an invasive infection with pneumonia, which can affect the heart, lungs, brain and kidneys.

GASTROENTEROLOGY
An ultrasound of 12 July 1991 reported ‘a mural polypi adjacent to the gall bladder’. In 2002 a CT scan of the lung stated that “fluid is seen within the oesophagus which . The only finding arising out of a colonoscopy / endoscopy in 2003 undertaken at public hospital was a diagnosis of “melanosis coli,” a pigmentation of the lining of the bowel normally ascribed to overuse of laxatives). The oesophagus was reported as “ normal” Some overseas studies have indicated that some patients are afflicted with melanosis coli who have never taken laxatives Melanosis coli can sometimes mimic ischemic colitis Thermography also clearly showed a significant area of inflammation extending from below the breastbone to the stomach.
Irrespective of the diagnosis no film of the procedure was retained. I was advised by the specialist Dr Mark Lane that “the images were not recorded –this is the norm in the situation where endoscopy reveals no abnormalities or the abnormalities are considered to be minor.”
One would have assumed that all procedural film was retained particularly in a public hospital for comparative purposes, if for no other reason. In this case there was a diagnosis . Clear images of melanosis coli were of course available on the internet from an American colonoscopy centre. Endoscopic procedures are now available on YouTube.
An abdominal ultrasound of January 2011 was assessed as normal apart from identifying “ 3 mm diameter gall bladder polyp”There has been no further investigation.
The GGT (Gamma-glytamyl transpeptidase) was reported by Labtests in January 2012 as 57 U/L ( norm: <50) H . GGT is an enzyme which is found in hepatocytes and biliary epithelial cells and may be high in liver disease. In particular it is a feature of biliary outflow obstruction rather than hepatocellular damage. GGT serum measurement provides a very sensitive indicator of the presence or absence of hepatobiliary disease. However the usefulness of measurement of serum GGT is limited by its lack of specificity. Raised GGT levels have been reported in a variety of clinical conditions including (1): pancreatic disease, myocardial infarction, chronic obstructive pulmonary disease, renal failure diabetes, obesity, alcoholism A low eGFR .(The Estimated Glomerular Filtration 68 mL/min/1.73m2 (>90)L was also reported. It is an indicator of kidney health. In adults, the normal GFR number is 90 or higher.
As a result of collapse preceeding an episode of haematemesis on 12 June 2013 I was admitted to Auckland Hospital. I remained in hospital for most of the day receiving fluids and an anti nausea injection. I returned home the same day and felt much better however I collapsed again the following day and was unable to get out of bed. I returned to hospital the following day. A Gastroscopy was performed by Dr Lane. The discharge summary dated 14 June 2013 reports as follows:
“Clinical Management: 63 year old presenting with 2 episodes of haematemesis on the background of regular NSAID use. ( note: there was only episode of haematemesis ). Her Haemoglobin was 53 and hence was transfused 3 units of blood in ED. Remained haemodynamically stable. Had a gastroscopy next day which showed gastric ulcer. This has been biopsied and the results are pending. She remained well following gastroscopy. Received a further blood transfusion of 1 unit. Hb was 99 today and she has been discharged home.
A gastroscopy was performed by endoscopist Dr Mark Lane and he reported “ the oesophagus was normal. One non-bleeding cratered gastric ulcer with pigmented material was found on the posterior wall of the gastric body. The lesion was fifteen mm by twenty mm in largest dimension. Biopsies were taken…the duodenum was normal”
On 21 June 2013 my blood pressure was recorded at 120/60 by nursing staff at One Health. A blood test result received from Labplus 20 June 2013 recorded the haemoglobin level as (94 g/L) ( 115-155) L/////////RBC: 3.23 x 10e 12/L ( 3.60-5.60) L///HCT: 0.29 l/l ( 0.35-0.46) L. Blood Film: Anaemia is present.
A further test by Labtests on 30 June 2013 reported a haemoglobin level of 110* ( 115-155) RBC of 377 ( 3.60-5.60) and an excessive platelet level of 443* ( 150-400)
On 12 June 2013 I was admitted to Auckland Hospital. The clinical summary dated 14 June 2013 reported “ …presenting with 2 episodes of haematemesis on the background of regular NSAID use. Her Haemoglobin was 53 and hence was transfused 3 units of blood in ED…received a further transfusion of 1 unit…gastroscopy showed a gastric ulcer
Labplus gastric ulcer biopsy report dated 20 June 2013 stated: “Macro: eight pieces of cream tissue that measure from 2mm to 4mm Micro: The sections sow multiple fragments of gastric bodytype mucosa with muscularis mucosa present. No ulceration is present. There is a mild increase in chronic inflammatory cells within the lamina propria accompanied by mild foveolar hyperplasia. No active inflammation is seen . No H pylori organisms are identified. There is no dysplasia or invasive malignancy. Diagnosis: Suggestive of regenerative mucosa”
I did not meet Dr Lane after the gastroscopy however he did comment about “ the fate of Miss Wilson” prior to the procedure. As has been the case in the past there were one or two unfortunate comments from the staff . While visiting my mother in her ward an unidentified person who was obviously Maori was overheard referring loudly to “ a bastard mental case” while standing in the corridor. A Maori or Island Female nurse on night duty wandered into my ward and passed a “ kill Vicki” comment. A gastric bleed was precipitated by an anti-inflammatory tablet. A faecal occult blood test performed by Northland pathology on 16 December 2015 was “ negative”.
In November 2015 there was evidence of some internal bleeding as evidenced in black stools precipitated by a once only anti-inflammatory tablet. On this occasion the problem was eliminated with a natural remedy namely cinnamon. Organic Facts : “Healing:Cinnamon acts as a coagulant and helps to stop excess bleeding. Therefore, it facilitates the healing process”.
Liver and Renal function tests performed at Northland Pathology on 25 September 2017, 11 May 2018 and 6 May 2019 were within the normal range.
Egfr m/L/min/1.732m2 61 ( Range >90) An Egfr > 60Ml/MIN/1.73m2 suggests normal kidney function in the absence of other evidence .On 6 May 2019 eGFR was *57. (>90). 12 December 2020 *56 Sodium potassium and creatinine levels were all within the normal limits.
In August 2018 I had experienced a pain in the lower abdomen which resulted in a period of paralysis involving my legs- I was unable to lift my legs over the side of the bed. This condition lasted for a day and was not repeated. On 3 August 2018 I attended at the Emergency Department at Northland Hospital (I had been previously hospitalised as result of a haemorrhage from a duodenal ulcer in 2013.)
Blood and urine tests were undertaken and I was advised that were normal. A CT scan was scheduled but later abandoned. I was in the care of an Irish female Dr Lyons. ED Director Dr Cameron’s when scheduled visit did not eventuate. Subsequent to a physical examination Dr Lyons advised that my situation did not comply with ED criteria for further investigation “ she would have an inpatient scope if she was newly anaemia had haematemesis-an outpatient scope could be arranged if she does not fulfil these criteria” and she advised that a recommendation would be sent to my General practitioner for further investigation to be implemented at the Gastroenterology clinic A gastroscopy was performed at Whangarei Hospital on 16 September 2019.
Anion Gap reading of 17 mmol/L H 8-16 was reported by Whangarei Hospital on 2 August 2018
Med line Plus states: The anion gap is a measurement of the difference-or gap-between the negatively charged and positively charged electrolytes. If the anion gap is either too high or too low, it may be a sign of a disorder in your lungs, kidneys, or other organ systems.
The anion gap blood test is used to show whether your blood has an imbalance of electrolytes or too much or not enough acid. Too much acid in the blood is called acidosis. If your blood does not have enough acid, you may have a condition called alkalosis.
If your results show a high anion gap, you may have acidosis, which means higher than normal levels of acid in the blood. Acidosis may be a sign of dehydration, diarrhea, or too much exercise. It may also indicate a more serious condition such as kidney disease or diabetes.
Mild acidosis may not cause any symptoms or it may be associated with nonspecific symptoms such as fatigue, nausea, and vomiting. Acute metabolic acidosis may also cause an increased rate and depth of breathing, confusion, and headaches, and it can lead to seizures, coma, and in some cases death.
Those that affect respiration and cause changes in pH due to changes in CO2 concentration are called respiratory acidosis (low pH) and respiratory alkalosis (high pH). Respiratory acid-base disorders are commonly due to lung diseases or conditions that affect normal breathing.
Disorders that affect metabolism and cause changes in pH due to either increased acid production or decreased base are called metabolic acidosis (low pH) and metabolic alkalosis (high pH). Metabolic acid-base disorders may be due to kidney disease, electrolyte disturbances, severe vomiting or diarrhea, ingestion of certain drugs and toxins, and diseases that affect normal metabolism (e.g., diabetes).
Abnormal leucocytes Ca 15 Leu/l were reported on 2 August 2018
Anytestkits.com advise: “ Normal leukocytes range in urine 0 – 10 leu/ul///////Measuring range 0 – 500leu/ul/////Leukocytes levels in urine This test indicates whether white blood cells are present in urine.///pathological concentration: more than 20 leu/ul.//////abnormal leukocytes values may indicative of : Cardinal symptom of urinary tract infection///////kidney infection////cystitis/urethritis//// ///Contamination//vaginal secretion
Further action is required if leukocytes are found in urine’
The Albumin/Creatinine Ratio test performed on 5 July 2019 from a random urine sample was normal.
ALBUMIN/CREATININE RATIO (Random Urine Sample)Date: 05/07/2019 Northland Pathology
Ref. Range:Ur.Albumin mg/L < 3 (< 30)////Ur.Creatinine mmol/L 4.1 /////Alb/Creat ratio mg/mmol < 1.0 (< 3.
Medline Plus advises: “A microalbumin creatinine ratio is most often used to screen people who are at higher risk for kidney disease. These include people with diabetes or high blood pressure. Identifying kidney disease at an early stage can help prevent serious complications.”
A Norpath midstream urine dated 11 September 2019 reported “Leucocytes and Erythrocytes : < 10 x 10 (6) L Ref Range (<40) and < 35)//( Epithelial Cells 1 x 10 (6)/L culture is not routinely reported in the absence of pyuria.”
An upper GI endoscopy report dated 16 September 2019 from NDHB Gastroenterology stated “The second portion of the duodenum, the duodenal bulb, the Pylorus, and the lower third of the oesophagus were all examined. “Findings : Oesophagus normal, stomach normal, the examined duodenum was normal. Scattered minimal inflammation was found in the stomach. A test for H Pylori Urease was negative.” Indications: suspected gastro-oesophageal reflux disease . A 2002 ADHB report of a CT chest scan stated that “fluid is seen within the oesophagus which is a little thick walled”, and a CT of the chest dated 27 October 2016 reported “a hiatus hernia.”
In 13 June 2013 ADHB reported “a cratered gastric ulcer with pigmented material was found on the posterior wall of the gastric body . The lesion measured fifteen by twenty mm in largest dimension” References to possible reflux disease would obviously be of secondary concern to the main reason for the procedure namely an episode of haematemesis/coagulase in June 2013 which required a transfusion of 4 units of blood any reference to which was omitted from the 2019 report. The latest NDHB images do not appear to be quite as specific as the original images of June 2013 which are somewhat enlarged , photographed from a different angle and clearly showed the duodenum’s posterior wall.
On 2 September 2019 Dr Miller of Bush Road Medical Kamo referred my to Gastroenterology at Whangarei Hospital for a colonography. Despite booking clerk Michelle’s advice that there was the likelihood of a strike on the day of my appointment and odd advice that the courier was NZ Van Lines, the procedure has been scheduled for late November.
CT COLONOGRAPHY:26 NOVEMBER 2019
CLINICAL DETAILS: Change in bowel habits and constipation. No family history of colon cancer. TECHNIQUE: Unenhanced low dose, supine and prone acquisition following automated colonic insufflation with carbon dioxide COLONIC FINDINGS: No colonic mass or significant polyp . EXTRACOLONIC FINDINGS:(Extra colonic evaluation is limited by the low-dose CT technique and lack of intravenous contrast) Solid Abdominal Organs: [No gross abnormality within the limits of the low dose unenhanced technique.] Abdominal Aorta: [Normal calibre] Other: [No lymphadenopathy or ascites]
COMMENT: No colonic mass or significant polyp.
Reported by:Dr Ziad Hamid
ULTRASOUND RENAL TRACT WDHB 09/10/2021 (Pandemic protocol,)
Thank you for referring your patient for ultrasound assessment.
INDICATION
Falling renal function over the past 6/12. BP well controlled.
FINDINGS
Both kidneys have a mild increase in parenchyma echogenicity, with preserved corticomedullary differentiation.
The kidneys are normal in size, shape and echotexture for age.
No dilatation of the ureters found.
The bladder is normal. The post void volume is 7 cc.
OPINION
Echogenic renal parenchyma of medical renal disease. No stone disease.
Reported by Dr Bruce Allen FRANZCR, Horizon Radiology. Patient: Vicky Wilson, NHI: GRD8664, DOB: 0207/1949. – requested by Dr A Thorpeh
11/11/2021 : Sodium 129 mmol /L ( 135-145( L )///Potassium 4.1 mmol/L ( 3.5-5.2)//Creatinine 113 umol/L ( 45-90) H///// eGfr 42 L/min/1.73m2 L

Renal tests dated 16 February 2022 are as follows: Sodium 131 mmol/L (135-145) L//// Potassium 3.8 mmol/L ( 3.5-5.2)////Creatinine 91 umol/L H ( 45-90) ///////////egFr 54 mL/min/1.732 L //// 5/5/2022 63

Continued low eGFR (30-59 mL/min/1.73m2) suggests moderate chronic kidney disease. Suggest you consider further investigation including assessment of proteinuria and cardiovascular risk factors if not already done.
On 26 March 2022 I was unable to see the specialist at ED (impacted stool) and subsequently received a large quantity of laxatives from Shore A&E the following day.
General Chemistry tests performed at Waitemata DHB ED on 26 March 2022 TEAM, Emergency Department
Sodium 133 mmol/L L 135-145////////Potassium 2.7 mmol/L L 3.5-5.2//////////Glucose 5.4 mmol/L 3.0-11.0/////// Creatinine 86 umol/L 45-90//////////Phosphate 1.01 mmol/L 0.75-1.50////////Calcium 2.45 mmol/L 2.10-2.55//////////Calcium (albumin adjusted) 2.40 mmol/L 2.10-2.55////////Albumin 44 g/L 32-48//////Protein 79 g/L 64-82///////////Globulin plasma 34 g/L 25-41/////////Bilirubin 19 umol/L <25///////////GGT 19 U/L 0-50////////Alkaline Phosphatase 79 U/L 40-130////// ALT 10 U/L <45 Lipase 35 U/L 8-78 5/5/2022 Sodium 134*(L)//Potassium 4.1 ////Creatinine 81 ///// . Suggest you consider further investigations including assessment of proteinuria CI and cardiovascular risk factors if not already done. eGfr 36 L/min 1.73m2 contiued low eGFr ( 30-59)mL/min/1.73m2 suggests moderate chronic kidney disaease135-145

Primary Diagnosis – Hypokaleaemia secondary diagnosis constipation.Low potassium (hypokalemia) refers to a lower than normal potassium level in your bloodstream. Potassium helps carry electrical signals to cells in your body. It is critical to the proper functioning of nerve and muscles cells, particularly heart muscle cells.? Constipation. What can cause hypokalaemia? Alcohol use (excessive)///////Chronic kidney disease.////Diabetic ketoacidosis.//Diarrhea.//Diuretics (water retention relievers)//Excessive laxative use//Excessive sweating.///Folic acid ficiency.
Liver function tests: 2/8/2021 Total bilirubin : 2/8/2021 10/////5/5/2022 12 (<25)///////Alk Phosphate :2/8/2021 60///5/5/2022 74 (40-130)///CGT 2/8/2021 24///5/5/2022 24 ( <50)//////ALT: 2/8/2021 12 ////5/5/2022 12 ( <45)/////////Total Protein: 2/8/2021 69// 5/5/2022 70/////( 64-82)///////Albumin: 2/8/2021 41///5/5/2022 41 ( 32-48)/////Globulin:2/8/2021 28///5//5/2022 29 ( 25-41)
General Comment
Authorised by Siemens Atellica
The plasma phosphate reference intervals were updated on 09/07/2021 following a review of literature and local data. The lower limit for infants has increased from 1.00 mmol/L to 1.40 mmol/L. For other ages, the changes are relatively minor. Comment added by: Siemens Atellica

POCT Urine analysis 26/03/22
Glucose Negative////// Ketones:Negative////// Blood/Haemoglobin: Negative///// pH 7.5///// Protein/Albumin:Negative//// Nitrite Negative//// Leucocyte esterase: Small amount///Specific Gravity:1.020
Point of Care Urine Chemistry
This sample has tested positive for one or more analytes. Please discuss with the treating clinician and, if clinically indicated, send this urine to the laboratory for further investigation
Leukocyte esterase is a screening test used to detect a substance that suggests there are white blood cells in the urine. This may mean you have a urinary tract infection. If this test is positive, the urine should be examined under a microscope for white blood cells and other signs that point to an infection.
Mid Stream Urine 26 March 2022
MICROSCOPY: White cells 20x10e6/L/////Red cells <10x10e6/L Epithelial cells <10x10e6/L No bacteria seen///No mucus//No yeasts seen/// colony count: no growth 8 May 2022: diabetic profile 2/8/2021 34/////5/5/2022 37 ( Range <41) //23 /11/2022 HbA1c:36 mmol/mol ( < 41 ) Renal function tests 23/11/2022 Sodium:134 mmol/L ( 135 – 145 ) L///// Potassium:3.9 mmol/L ( 3.5 – 5.2 ) Creatinine:75 umol/L ( 45 – 90 ) eGFR:68 mL/min/1.73m2 Comment:An eGFR > 60 mL/min/1.73m2 suggests normal kidney function, in the absence of other evidence (e.g. hypertension, albuminuria, haematu-ria) of kidney damage. It is less reliable in patients with extremes of body weight, muscle disease or severe liver disease.

Muscle enzymes: 23/11/2022 CK:146 U/L ( 30 – 180 )
Liver function tests: 23/11/2022 Total Bilirubin:13 umol/L ( < 25 )///Alk. Phosphatase:78 U/L ( 40 – 130 )////GGT:20 U/L ( < 50 )////ALT:12 U/L ( < 45
Total Protein:67 g/L ( 64 – 82 )////Albumin:41 g/L ( 32 – 48 )///Globulin:26 g/L ( 25 – 41

General chemistry tests -waitemata DHB 31 March 2023. Sodium 128mmol/ (L) (135-145)//////egFR 62 m/L/min/1.73 (L)/////CRP 5 mg/L (H) //// All other test were within the normal range

What cancers are associated with high CRP levels? Cleveland Clinic advises ”The most reported new cases involve the lung and breast, with colorectal cancer third, prostate cancer fourth, and stomach cancer. Mt Sinai New York states: A CRP test result of more than 50 mg/L is general-ly considered servere elevation.Results over 59 mg/L are associated with acute bacterial infections about 90% of the time”

CARDIOLOGY
A follow-up Angiogram in June 03 instigated by cardiologist Dr Ellis indicated “calcium within the left coronary artery an occluded proximal circumflex with one major OM branch which cross-filled from both the LAD and RCA territory, mild-moderate LAD lesions ,and mild RCA lesions”. The general assessment was .of “an occluded proximal circumflex , mild-moderate LAD mild RCA lesions and generally good LV systolic function. There was no suggestion of either LV systolic impairment or damage to the LV”. The possibility of opening the heart vessel was considered a possibility but considered unlikely at the time of the investigative procedure.”
Ecchocardiography of 10 June 2003 indicated “ that the LV was not dilated with LVEDD 4.9 cms and LVESD at 3.4 cms. There was normal Doppler indices through the mitral valve and pulmonary veins indicting good LV diastolic function. The left atrium was not dilated at 3.3cms. The mitral valve was structurally normal opening freely and closing with trivial MR> The aortic valve is trileaflet, mildly thickened and calcified, opening freely and closing with trivial AR.. The aortic root is 2.9 cms and there was normal Doppler velocity through the aortic valve at 1.1M/sec. The right heart is structurally normal including the tricuspid valve, which opens freely and closes without TR. There is normal Doppler velocity through the main pulmonary artery at 0.8M/sec and the interarterial septum is intact” The carotid artery ultrasound scan of 18 June 03 showed “mild/moderate carotid lesions but none so severe that they would require revascularization. There was no significant stenosis of either common, internal or external carotid artery. Anterograde flow was present in both vertebral
A carotid duplex ultrasound was performed at Mercy Hospital on 18 June 2003 Pressures in the right common carotid was systole 69 /diastole 21/// left internal carotid (LICA) were reported as systole(78cm/sec)// diastole ( 28 cm/sec. The RICA was systole 95// diastole 43. Pressures in the LECA were recorded as systole 77 // diastole (9.) . RECA pressures were systole (57) // diastole 14. The readings were classified as essentially normal?
Pressures are as follows:
Right: systole diastole Plaque Tortuosity Stenosis%

Common carotid 69 21 soft Lateral bifurcation Mild Minimal Nil
Internal carotid 95 43 None seen Minimal Nil
External 57 14 None seen Minimal Nil
Vertebral Anterograde flow
Carotid bifurcation: Normal ICA/CCA 1.38 Technical quality: Good
Left:
systole diastole Plaque Tortuosity Stenosis%

Common carotid 79 21 Soft Medial distal Moderate Minimal Non-significant ((50%
Internal carotid 78 28 None seen Minimal Nil
External 77 9 Nil
Vertebral Anterograde flow
Carotid bifurcation Normal ICA/CCA 0.99 Technical quality: good

Summary: Sonographer: Lindsay Howitt
No significant stenosis of either common, internal or external carotid artery. Anterograde flow present in both.
.

A report from Coosa Valleys Technical College advises that “Normal velocities of the carotid arteries have not been established . The reported mean peak systolic value (PSV) of the ICA is from 54 to 88 cm/sec and not viewed as abnormal until PSV exceeds 100 cm/sec The mean PSV of the ECA( External carotid artery) is 77cm/sec with the maximum velocity not exceeding 115cm/sec”
In 2005 Cardiologist Dr Clarke’ s report stated “ that blood pressure prior to exercise testing was 150/90. After 3 minutes of walking on the treadmill it dropped to 140/70 and then went up to 180/80. Five minutes after the exercise test was completed her blood pressure was 146/90 at a heart rate of 85/bpm. She had chest discomfort before during and after the test and it didn’t really change. Her effort tolerance was 7 minutes of the Bruce protocol. There was minor ST segment changes which were certainly no worse than on the test done in 2003. Dr Ellis investigated her in 2003 and found her to have an occluded left circumflex and minor coronary disease in the LAD and right coronary with normal left ventricular function A repeat angiogram was ruled out in favour of a possible stress echocardiogram test in the future. I have no evidence that there has been progression of her coronary disease.”
An ECG was undertaken at public hospital in September 2008. I was advised that the ECG report was not available to the patient. In his letter dated 8 April 2009 the Chief Medical Officer Dr Sage he “that the ECG was not normally reported on but was used by doctors to exclude any significant cardiac abnormalities-this ECG is definitely no cause for your concern” I provided copies of relevant previous cardiology reports to public hospital but despite my query the only acknowledgment has been a reference to “numerous enclosures a-r” contained in a letter from the Chief Medical Officer.
Blood pressure readings have ranged from 170/90 in October 2007 , 158/90/ in May 2009, 180/100 in February 2010 and 170/90 in July 2010. They have reduced to more normal levels in 2011 and 2012-2018.
There was a a further consultation with senior cardiologist Dr Ted Clarke on 28 January 2011. As with the respiratory physician an x ray monitor was not available the plates being viewed instead on the window pane. ! I pointed out what appeared to be an apparent expansion in the area of the heart in comparison with the x ray of 1989- chest x ray is generally regarded as being a reasonably accurate indicator of cardiomegaly.
A resting ECG was undertaken and Clarkes report stated “ appeared to be within the normal limits. One might argue about the ST segments being a little bit saggy- she didn’t have any heart murmurs no evidence of pulmonary arterial hypertension and I could find no abnormal sounds on listening to her lungs even after coughing. She has a little bit of pitting oedema of both ankles. The JVP is not elevated. She has a concern too about the fact that her most recent chest x rays when compared with those of 1989 show a definite enlargement of the cardiac silhouette and I would have to agree with her –certainly no sign on the most recent x rays of any left ventricular failure”
Subsequent to the consultation there were comments overheard from the cardiologist to a visiting young man to the effect that either myself or a woman with the same Christian name had apparently been cited by a former minister of police in connection with behavioural aspects. A female hospital staff member wearing a blue uniform was later overheard standing outside in the car park using her phone. She also reiterated the same comment. Police cars together with the fire brigade and a helicopter in the near distance passed by on the road outside the practice after two consultations.
A stress echocardiogram was performed at Ultravision Cardiac Imaging Mercy Hospital Auckland on 11 February 2011. “ At peak heart rate and in particular in recovery there was 1.5mm downsloping inferolateral ST segment depression associated with T wave inversion –Baseline: normal left ventricular size with hypokinesis of the mid to distal inferolateral and anterolateral segments. Overall LVEF is lower limit normal. Normal left ventricular wall thickness and mild left ventricular diastolic dysfunction. No significant valvular abnormalities. Normal right ventricular size and function.
At Peak heart rate: there was evidence of a large territory of ischaemia in LAD territory with severe hypokinesis of the mid to distal anterior septum, mid to distal inferior septum, distal anterior wall extending to the entire apex and distal inferior and inferolateral walls. There appears to be minor augmentation of the inferolateral wall. The left ventricular ejection fraction reduced.
Conclusion: exercise induced chest discomfort at a low workload associated with ischemia in the LAD territory resting wall motion abnormality consistent with known circumflex occlusion
The Mayo Clinic advises “the left ventricle is the heart’s main pumping chamber, so ejection fraction is usually measured only in the left ventricle (LV). An LV ejection fraction of 55 percent or higher is considered normal. An LV ejection fraction of 50 percent or lower is considered reduced. Experts vary in their opinion about an ejection fraction between 50 and 55 percent, and some would consider this a “borderline” range
The ejection fraction may decrease if:
You have weakness of your heart muscle, such as dilated cardiomyopathy
A heart attack has damaged your heart
You have problems with your heart’s valves
You have had long-standing, uncontrolled high blood pressure
A Diagnostic Medlab report dated 24 February 2011 indicated a total cholesterol measure of 6.0* together with an LDL level of 3.7* and Triglyceride of 2.4). Total cholesterol in October 2012 measured 4.8. In December 2015 the CHOL/HDL ratio was 5.9 ( norm <4.5) At the subsequent consultation with the cardiologist It was never entirely clear whether the cd/dvd of the procedure was available but it was never produced at the consultation. The specialist also queried the fact that I would want copy of the film considering that his report should suffice. “Preliminary findings: Triple vessel disease : 60 distal left main. Severe proximal LAD. Moderate diagonal ostium Severe proximal intermediate LCx=Proximal occlusion . RCA mild disease. Collaterised to LCx. Good LV function. Quadruple coronary artery by-pass recommended”. An Angiogram was performed at Auckland Hospital on 30 March 2011 The procedure was somewhat marred by the removal of my footwear from beside my bed. I had to resort to travelling home in bare feet. There were the usual background comments from the staff some pertaining to “ property” and others referring to the derogatory comments of an Australian psychiatrist concerning mental health.! : Although a quadruple bypass was initially recommended the cardiologists agreed with my request and triple stenting procedure of the LAD was subsequently performed at ADHB on 15 November 2011. by Drs Webster and Glenie There were no initial complications. I attended a follow up consultation with the Dr Webster on 16 January 2012. He first checked my chest with a stethoscope. His report referred to “percutaneous coronary interventional procedure to the left main and proximal left anterior descending disease. She is still getting some chest pain requiring nitroglycerine 2-3 times per week. She has also been troubled by recurrent chest and sinus infections . She has some discomfort in her lower legs associated with mild ankle swelling. She has no other symptoms of note and is not getting claudication in her legs. Her medications are unchanged. Examination of her cardioivascular system was unremarkable apart from a slight reduction in the right dorsalis pedis pulse compared with the left. Clinically this woman is doing reasonably well from a cardiac viewpoint. Her ongong angina may relate to the chronic left circumflex occlusion. At present I suggested that we continue with a conservative approach with a planned review in four months time. If she has ongoing symptoms repeat angiography with view to a possible attempt at opening the circumflex could be considered.” I have experienced discomfort in legs previously most often associated with infection but it has generally responded to antibiotics. Peripheral arterial disease in the legs is a common problem and is often assessed by an ultrasound, arterial-brachial index or an arteriogram. The use of high levels of atorvastatin can also cause generalised pain. The level of discomfort remains unchanged in April 2012. No investigative procedures were recommended at this time and he said he would arrange another consultation in about 4 months time. My blood pressure height and weight were assessed as 132/65, 161cms and 62.9 kgs respectively.) The CRP was reported as 5 mg/L on 17 January 2012 (<5) H-and my blood pressure was again elevated at 170/94 in February 2012. My blood tests dated 16 January 2012 indicated a much higher than normal level of creatine kinase at 358 U/L H ( norm 30-180) . The additional comments from labtests stated “ that unexpected elevations of CK are usually due to exercise or muscle trauma. Other relatively common causes are medication ( eg statins) hypothyroidism, alcoholic myopathy and myocardial infarction though the latter is is seldom an unexpected finding. Rarer but important causes are diseases of skeletal muscle ,CNS and a wide range of metabolic disorders.” A medical website states that “the enzyme creatine kinase (CK) and one of its forms called CK-MB present a similar situation. CK is released into the bloodstream by damaged muscles; CK-MB is released into the bloodstream when the heart muscle is damaged. Therefore, a high level of CK-MB indicates damage to the heart muscle, so this enzyme is one of the indicators used to diagnose heart attacks. Because of their greater muscle mass, men tend to have higher CK levels and the level of CK-MB that indicates a heart attack in men is higher than for women. When the test first came into use, the reference range was based on the higher levels. Many elderly women being tested for a heart attack demonstrated considerably lower levels of CK-MB (because of their smaller muscle mass) and, thus, did not pass the threshold level believed to indicate a heart attack; so heart attacks were often missed in these women.” In his report dated 20 January 2012 specialist advised: that “ her creatine kinase level to be elevated at 358 which is about twice the upper limit of normal. This may be due to atorvastatin ( Lipitor). I would be loath to discontinue the medication but that might need to be considered should her symptoms worsen. Alternatively simvastatin could be tried , although this is less potent and also associated with myalgias, particularly at higher dosages Centre for Adverse Reactions of Dunedin reports as follows:Myopathy known to occur with statins .Statin treatment should be discontinued immediately if an elevated CK level is found (i.e. CK >10 x upper limit of normal), or where myopathy is suspected or diagnosed. If there is a moderate rise in the CK level (i.e. 3-10 x upper limit of normal) then monitor CK levels weekly and seek specialist advice. It is worth noting that measuring CK levels when statin therapy is initiated will provide a reference baseline; however, undertaking regular CK levels is probably not useful in the absence of therapy changes or the development of co-morbidity.
Atorvastatin can cause//Insomnia and Chest_pain”Chest pain and Abdominal pain, constipation, diarrhea, dyspepsia, flatulence, /Arthralgia, myalgia, back pain, arthritis //Sinusitis, pharyngitis, bronchitis, rhinitis ” Infection”Infection, flu-like syndrome, allergic reaction
In November 2013 I received the ECG graphs which were performed on 12 and 13 June 2013 at Auckland Hospital as a result of the haematemesis . The graph of 12 June clearly indicated “ “sinus tachycardia –septal infarct” A subsequent ECG on the same day reported “sinus tachycardia with short PR ST and T wave abnormality consider anterolateral ischemia
Tachycardia refers to an abnormally fast resting heart rate.
The health website ASK advises that “ A septal infarct is a condition in which the septum of the heart has a patch of dead or dying tissue. This typically results after a heart attack. The prognosis for a septal infarct is a 69 percent chance of survival for living past six years. Survival rate can increase or decrease depending on a person’s general health and their age. A younger person has a higher rate of survival compared to an elderly person.”
“Anterolateral ischemia is a medical term that refers to a condition that is characterised by very little amount of blood flowing to the back side of the heart. This is usually as a result of blockage in an artery responsible for the blood flow” The original diagnosis of occluded proximal circumflex ( which extends around the back of the heart) has yet to be dealt with.
A Basic haemostasis screen was provided by Labplus at Auckland Hospital on 12 June 2013. APTT test was 25 ( norm 25-37) . APTT (Activated Partial Thromboplastin Time) is a measure of one part of the clotting system known as the “intrinsic pathway”. This pathway involves a number of coagulation factors, which are proteins involved in the normal clotting process. The APTT is used to measure the effects of treatment with intravenous (IV) Heparin therapy, to ensure that the blood is not thinned too much or too little. Conditions which may be treated with IV Heparin include:
Deep Vein Thrombosis (DVT)//Pulmonary Embolism (PE)//unstable angina – now more commonly known as Acute Coronary Syndrome (ACS)//Atrial Fibrillation (AF)
The tests also included PR and Fibrinogen Assay . PR measure 1.0 (norm 0.8-1.2) The fibrinogen Assay result measured 3.0 ( norm 1.5-4.0) .
A Labtest for lipids on 16 september 2013 indicated generally high readings. Cholesterol 7.1* (< 5.0) Triglycerides 2.3* (<2.0) HD 1.28 ( > 1.28) LDL cholesterol 4.8* ( <3.4) Chol/ HDl ration 5.6 (<4.5) Blood pressure in September 2013 measured 115/71 I requested an angiogram and a leg ultrasound and he advised that he would arrange both of those procedures. My blood pressure was 176/83. I provided Webster with a photo of the haematemesis which occurred a few months earlier. Apart from saying “ it was quite impressive” he made no other comment. Neither the details concerning the septal infarct and ischemia detailed in the ECG nor any reference to heart valves were reported in any of Webster’s reports. Regardless he proceeded with further stenting in November. An angiogram was performed on 26 November 2013 The clinical summary dated 26 November 2013 reported: “ Preliminary results : left main stem proximal LAD, mid LAD stents patent. Severe ostial posterior descending artery disease L) circumflex occluded. Severe stenosis at the distal edge of mid/distal LAD stent. Deployment of 2.25 mm x 12mm x Xience drug-eluting stent with an excellent result. 6 months of clopidogrel prescribed.” A stress echogcardiogram of February 2011 reported “that the left ventricular ejection fraction was reduced”-a notation on the coronary diagram of November 2013 noted that “ the LVEF was not done” There was a further consultation with Dr Webster on 17 February 2014. “ she has been reasonably well?-she has had ongoing troubles with chest infections and notes an occasional twinge in the chest with coughing…..legs ..an ultrasound has been arranged in the past but does not appear to have happened…she has longstanding dull headaches and generalised lethargy. She saw Dr Ernest Willoughby in December 2013 following an episode of grey patches coming down over both eyes for 15 minutes. This was associated with light headedness and her heart was not racing at the time. She has had nothing since .On examination she was not distressed. Her pulse was 80 and regular .Her blood pressure was 114/58. He jugular venous pressure was not elevated. I could not hear a carotid bruit. Heart sounds were dual. I have re-booked a leg ultrasound . Willoughby felt that her visual symptoms might be related to ischaemia in the posterior circulation . I would like to review he in nine months.” Webster still considered that nothing further needed to be done in respect of the occluded circumflex artery. Although in 2012 he advised that “If she has ongoing symptoms repeat angiography with view to a possible attempt at opening the circumflex could be considered.” Dr Diana Holdright a consultant cardiologist from Harley Street in London advises that “ Narrowing in the carotid arteries increases the risk of stroke and TIA (mini-stroke), and narrowings in other arteries, such as the coronary arteries, frequently co-exist. More recently it has been appreciated that subtle and early changes in the inner lining of the arteries, such as an increased thickness of the “intima and media”, are associated with an increased risk of stroke and heart attack” ( see also carotid ultrasound of 2003) An ECG which was performed at Whangarei Hospital on 13 March 2015 at the instigation of Dr Kennedy indicated “ a possible inferior infarct- abnormal ECG” . This was not discussed during the consultation however Kennedy did refer to it in his report: “ A resting 12- lead ECG today showed sinus rhythm 70/min normal QRS axi, small Q waves in the inferior leads , not reaching levels of significance no left ventricular hypertrophy or strain minor T wave flattening in the anterosepetal leads.” “A chronically occluded left circumflex” which was also referred in his initial summation, is still outstanding from an initial diagnosis by Dr Ellis of Auckland in 2003. A stress echo was performed at whangarei Hospital under the auspices of Dr Nandra. His report dated 14 July 2015 is as follows:” Vicki managed 3 minutes 36 seconds of the Bruce protocol today. The test was stopped secondary to chest discomfort. Resting ECG showed normal sinus rhythm mild inferior lateral ST depressions…..Heart rate rose from 83 beats per minute to 127 beats per minute ( 82% of maximum age predicted heart rate) target heart rate not achieved. Resting blood pressure was 163/75 mmHg which rose to 190/108 mmHg. Peak exercise ECG did show ST depressions but not significant enough to call it positive. Resting echo showed multiregional wall motion abnormality with mild to moderate LV systolic disfunction. Multiple segments including apical septal/anterior/inferior/and posterior wall akinesia. During exercise LV dilated and showed dyskinetic changes mainly to the anterior wall which correlated with her symptoms and hence the test was deemed positive. An angiogram was performed at Auckland Hospital on 12 August 2015 by Professor Peter Ruygrok . The preliminary report in the clinical summary dated 12 August stated” Severe triple vessel disease. Normal left ventricular function on left ventriculogram. Plan: out patient coronary artery by-pass surgery” Spirometry chest x –ray and check of varicose veins done prior to discharge” (The vein check was not done). However the report did not refer to the stress echo performed at Northland DHB on 14 July 2015. Dr Ruygrok didn’t consider that occluded proximal circumflex which has been outstanding since 2003 was a candidate for stenting as the hardened plaque would be a preventative!. (similar case histories on the internet have resulted in success for some patients effected by a change of surgeon, balloon angioplasty and/or the rotorblade technique) In his report dated January 2012 Dr Webster stated that “ her ongoing angina may relate to the chronic left circumflex occlusion. If she has ongoing symptoms repeat angiography with view to a possible attempt at opening the circumflex could be considered.” An ECG at ADHB of 12 June 2013 reported : “Sinus tachycardia with short PR ST and T wave abnormality consider anterolateral ischemia” This was subsequent to an episode of haematemesis. Another ECG on the same day specified “ Septal infarct” Subsequent ECGs 13 March 2013 and 22 April 2015 at Northland DHB stated: normal sinus rhythm possible inferior infarct ////Sinus rhythm with short PR – possible inferior infarct” In their emails dated 18 and 19 August 2015 Professor Ruygrok and Dr Mark Webster advised that “ there were complete blockages involving all 3 main coronary arteries and a significant narrowing in one of the other important branch vessels. Coronary bypass graft surgery with grafts to the downstream vessels is the best option” I have elected not to have coronary bypass surgery as my preference is angioplasty/stenting. Lipid tests( non-fasting:) Northland Pathology Date: 16 December 2015 25 September 2017 11 May 2018 Cholesterol(mmol/L) as 5.7(< 5.0) 4.3 ( Range <5.0) 4.0 Triglycerides 3.1 (<2.0 1.7 ( Range <2.0) 1.5 HDL Cholesterol 0.97* (>1.00) 1.13 (Range>1.00) 1.05
LDL Cholesterol 3.3( <3.4) 2.4 (Range <3.4) 2.3 CHOL/HDL ratio 5.9* (<4.5) 3.8 (Range <4.5) 3.8 Diabetic Profile Date: 25 September 2017 HbAlc mmo1/mo1 34 ( Range < 41) 34 Troponin Date 28 August 2017 < 5 ng/L ( Range < 14) I met Cardiologist Dr Leigh Nairn at Whangarei hospital on 30 December 2015. His report is as follows: “ she has a history of ischaemic heart disease with an occlude LAD stent and occlusion of the circumflex and mid RCA arteries.. PCI is not technically possible and she has been recommended to continue with medical therapy or CABG if she has restricting angina symptoms” Examination, weight 67 Kgs, BP 124/76, Pulse 74/minute regular. CVP not elevated. Chest clear. Quiet systolic murmur at the LSE-apex. ECG showed sinus rhythm with Q waves inferiorly mild ST slurring in 1, AVL, V4-6. (Only “RCA mild disease” was reported in 2011” Dr Nairn stated that while the left descending artery was often stented the procedure was rarely implemented in respect of the left main.!. He made no reference to the latter in his report. Stenting procedures are commonplace in both of these arteries which are commonly known as “ the widow makers”! ADHB’s clinical summary dated 26 November 2013 referred to “stenting of t he distal left main and the left anterior descending artery which was performed in 2012 Severe proximal intermediate proximal occlusion of the left circumflex artery and mild right coronary disease. In 2013 there was “ severe stenosis at the distal edge of the mid/distal LAD stent . A further stent was deployed”. The cardiologist seemed to have difficulty locating the previous stress echo performed earlier this year. His report concluded: “ she had a mildly positive stress echo July 2015. The stress echo report stated “ multiregional wall motion abnormality Multiple segments including apical/septal/anterior /inferior and posterior wall akinesia. During exercise LV dilated and showed diskinetic changes mainly in the anterior wall”. “Prognostically she probably would benefit from CABG but in the absence of significant symptoms at the present time Vicki is releuctant to have CABG. She is not specifically on any anti-anginal medication at the present time and if she develops deteriorating angina then she should be reviewed in the cardiology OPD, and also have a trial of ISM or CCB. She is probably unlikely to tolerate beta-blockers because of a history of chronic fatigue fibromyalgia” There has been no contact with cardiology since 2015. An ECG was performed at Onerahi Medical Whangarei on 16 June 2018. Details are as follows: “ Warning: artefact in ( part of )recording-use interpretation with caution -sinus rhythm slight inferior repolarisation disturbance, consider ischemia , LV overload or a specific change. Borderline ECG. Unconfirmed report”. Changes are evident V4 and V3 in the latest graph in comparison with the graph of 2015. ECG: the Cardiology Clinic at Whangarei Hospital on 27 August 2018: prior to an appointment with cardiologist Dr Lee. There appeared to be no significant changes from earlier ECGs apart from an improvement in V3 and V4 segments. Lee advised “ I have not made any changes to Vickis medications. She does get a bit tight around the chest but this is only severe exertion but she has otherwise been stable without any deterioration in her symptoms There are no new ischaemic changes. The reality is that she would require bypass surgery but her symptoms have not been particularly progressive suggesting that she has a fair amount of collateralisation….Vicki only requires follow up every three years to see how she is getting on” He did not consider that a further stress echo was necessary nor a further check of stenting at ADHB. The American College of Cardiology advises: “You might need an imaging test if your symptoms come back or get worse. This includes symptoms such as chest pain, shortness of breath, feeling tired, or having trouble climbing stairs.. If you don’t have symptoms, you may still need an imaging test if: It has been more than five years since your bypass surgery.///It has been more than two years since your stent procedure.////You have blockages that weren’t treated during your first heart procedure////You have diabetes or aggressive heart disease.” Fibrinogen Assay test dated 2 August 2018 provided a reading of 4.7 g/L H (1.5-4.0) (Fibrinogen is one of 13 coagulation factors responsible for blood clotting) ESR and CRP are both inflammatory indicators- ESRs have ranged from 26 in July 2009, 34 in November 2009 , and July 2010, 21 in August 2011 and 17 in October 2012 (norm: 1-30). A CRP ( C-Reactive Protein norm : < 5) test dated 17 January 2012 was reported as- 6, 7 mg/L on 7 November 2014, 26 February 2015, and 16 December 2015. These tests have not been repeated. A CRP reading of 46 mg/L H 0-5 was reported on 2 August 2018, C-Reactive protein dated 15/2/2019, 6/5/2019 and 5/9/2019 measured 2 2mg/L and 3 mg/L and were within the normal range(<5)////26 March 2022 CRP 12 mg/L H 0-5//////23/11/2022 2 mg/L ( < 5 )//////////////31/3/2023 5 mg/L H (0-5) Patient .co.uk states : C- Reactive Protein (CRP) concentrations characteristically return to normal after seven days of appropriate treatment for bacterial meningitis if no complications develop. Serial monitoring of serum and CSF-CRP concentrations may be useful clinically. CRP is nonspecific and its clinical usefulness is therefore limited, especially in diagnosis. CRP is useful in monitoring disease activity in certain conditions (eg, rheumatoid arthritis, infections or malignancy) and as a prognostic marker for conditions such as acute pancreatitis. An increased CRP may be due to: Inflammatory disorders – eg, inflammatory arthritis, vasculitis, Crohn’s disease. Tissue injury or necrosis – eg, burns, necrosis, myocardial infarction, pulmonary embolus. Erythrocyte sedimentation rate ( ESR) and is a sensitive but nonspecific index of plasma protein changes which result from inflammation or tissue damage. Low ESR: polycythaemia, hypofibrinogenaemia, congestive cardiac failure, spherocytosis, sickle cells . ALBUMIN/CREATININE RATIO (Random Urine Sample)Date: 05/07/2019 Ref. Range: Ur.Albumin mg/L < 3 (< 30)//Ur.Creatinine mmol/L 4.1 ///Alb/Creat ratio mg/mmol < 1.0 (< 3.5) Lipid tests ( non-fasting) dated 5 July 2019 from Northland Pathology were within the normal range. Fasting Status Not stated Cholesterol mmol/L 3.8 (< 5.0)//Triglycerides mmol/L 1.6 (< 2.0)//HDL Cholesterol mmol/L 1.11 (> 1.00)////LDL Cholesterol mmol/L 2.0 (< 3.4)//Chol/HDL ratio 3.4 (< 4.5)
For established CVD risk (including diabetes) NZGG optimal levels are Cholesterol < 4.0, LDL < 2.0 and Chol/HDL ratio < 4.0.
I attended the ED clinic at North Shore Hospital on 6 May 2020 as I was afflicted with a chest complaint. “ Examination on presentation: BP: 128/45 mmHg///HR: 59 bpm////Temp: 35.9C Heart sounds dual///JVP normal////CRP: <3mg/L (0.5 mg/L) N
I met Cardiologist Dr Glenie on 12 November 2020. No heart checks were performed including a blood pressure reading. He did not consider that a subsequent consultation was necessary unless I experienced serious pain when heart surgery would be the only option. “Routine imaging of the left main stents is not indicated particularly in light of the recent ischaemia trial.” Website Seconds Count states: “Even when a stent is implanted, restenosis can develop inside the stent. But sometimes scar tissue forms under the healthy tissue. If that scar tissue grows thick enough, it can cause restenosis. With drug-eluting stents, the restenosis rate can be under 10 percent. If you have had an angioplasty procedure (with or without stenting), it is very important to have regular follow-up visits with your doctor.
Your doctor will monitor your health to make sure that you don’t have problems or complications.. This could include angina, shortness of breath, or chest pain with or without physical activity. If you do have symptoms your doctor may recommend tests, such as a stress test or an angiogram, to determine if you might have restenosis or a new blockage that may require further treatment. Healthline advises “ In the event that scar tissue forms after stenting your doctor may need to repeat the procedure. I have not had significant contact with the specialist who performed the stenting procedures since 2013.
Resting echo of 2015 at Whangarei Hospital showed: “multiregional wall motion abnormality with mild to moderate LV systolic disfunction. Multiple segments including apical septal/anterior/inferior/and posterior wall akinesia. During exercise LV dilated and showed dyskinetic changes mainly to the anterior wall which correlated with her symptoms and hence the test was deemed positive”.
Glenie considered that “there is no good percutaneous option for either of the LAD or circumflex occlusions. She also has a known mid right coronary artery occlusion…again there are no good intervention options from a percutaneous perspective.” In 2012 Dr Webster advised “that an attempted opening of the circumflex might be considered if there were ongoing angina symptoms”. Glenie further advised “She does have other significant medical history….she comes today for routine review-she gets minimal anginal symptoms-she does not get resting anginal symptoms… has chronic chest infections. Clinically she has dual sounds with no added murmurs. Her venous pressure is not elevated. There are no carotid bruits. She has occasional crepitation at the left base but otherwise the chest was clear????/ She has stable coronary heart disease the indication for a repeat angiogram would be for the consideration of coronary artery bypass surgery”. Although a blood pressure reading of 180/90 was referred to by respiratory physician Dr Chapman BP was not recorded by Dr Glenie.
A telephone consultation was conducted with Dr Scott cardiologist of Waitemata DHB on 16 November 2021. A consultation will be next scheduled in 6-12 months – a delay of 18 months-2 years between personalised consultations.
“Ms Vicki Wilson
Flat 7/36 Taharoto Road Takapuna 0622
NHI GRD 8664
Date: 16/11/2021
Visit Date: 16/11/2021

Cardiology Telehealth Clinic To: Dr Audrey K Thorpe, 16/326 Sunset Road, Mairangi Bay, Auckland 0632 cc:
Re: WILSON, Vicki -dob 2/07/1949 (Female) Flat 7/36 Taharoto Road, Takapuna, Auckland 0622

Medical Problems: Ischaemic heart disease.Angiogram 2015: Patent stent left main into proximal and mid LAD. Occluded LAD stent after second diagonal – well collateralised. Ostial occlusion LCx-well collateralised. Mid RCA occlusion. EF 60%No good percutaneous options (Tim Glenie). Bypass surgery discussed but patient not keen. Mild renal impairment currently: Hyponatraemia-sodium 129, creatinine 113, eGFR 42.
Fibroadenoma of the breast////Previous hysterectomy/oophorectomy//Previous bleeding duodenal ulcer//Previous Graves’ disease//Distant ex-smoker.Current Medication: Cilazapril 5 mg daily//Aspirin 100 mg daily//Bendrofluazide 2.5 mg daily/Omeprazole 40 mg daily//Carbimazole 5 mg ///twice daily//Amitriptyline 20 mg daily//On a statin? – LDL is low?
I spoke with Vicki by phone today in view of the current COVID-19 situation. As you note in your referral, she has concerns around monitoring her coronary vessels and indeed her carotid vessels. It does not sound as if she has significant angina however. I have discussed the fact that we do not routinely reimage coronary stents, unless there is evidence of important stenosis-recurrent angina. She had been advised around 2013 that if she had ongoing pain, it may be possible to attempt to open her circumflex vessel. When she was reviewed by Dr Glenie in 2020 however, he felt that there were no good percutaneous options to open either the LAD or circumflex vessels, particularly as she seemed to be well collateralised (natural bypass).
If however she did develop anginal symptoms, then t would be comfortable repeating her angiogram with a view to either intervening surgically or percutaneously if that were possible. Unless she develops symptoms however, I think ongoing aggressive risk factor and medical management is most appropriate for her. We talked briefly about her carotid arteries. She does have some haemodynamic data from an ultrasound done in the early 2000, however I am not in a position to interpret these. It does sound as if her stenoses were predominantly in the external carotids however. I would defer more detailed interpretation of these findings to the vascular surgeons. In view of the age of the investigations, the digital reports are not available to me currently owever.
I will arrange to see her in follow-up in 6-12 months’ time, but please contact me sooner if she develops symptoms or other cardiac questions or issues arise.
Yours sincerely Electronically sighted and approved by
Dr Tony Scott Cardiologist/Physician):
There appears to be a juxtaposition of undated test results. (The latest tests are below)
Abnormalities in the latest lipid tests from 2014 until are detailed below:
Cholestorol=H 16/12/2014= 5.6(fasting) 16/12/2015 5.7 14/9/2016 5.2* //
Triglyceride 2.8 *=H 16/12/2014 *////////26/2/2015 2.5* 16/12/2015 3.1////14/9/2016 2.5
Fibrinogen Assay =H (1.5-4.0) 2/8/ 2018 4.7g/L H Labtests online advises: A fibrinogen antigen test measures the amount of fibrinogen in the blood. Fibrinogen is produced by the liver and released into the blood along with several other clotting factors (also called coagulation factors). Lipid tests are as follows: Date: 16/12/15 4/9/2016 11/12/2020 8/2/2021 2/8/2021 5/5/2022 23/11/2022 Cholesterol 5.7 5.2* 3.1 4.1 3.4 4.3 ( Range <5.0) 3.1 mmol/L Triglycerides 3.1 2.5* 1.1 1.4 1.9 2.4* (Range <2.0 ) 1.2 mmol/L HDL Cholesterol 0.97 1.16 0.97* 1.24 0.96* L 1.11 (Range >1.0) 1.09 mmol/L
LDL Cholesterol 3.3 2.9 1.6 2.2 1.6 2 .3 (Range < 3.4) 1.5 mmol/L
Chol/HDL ratio 5.9* 4.5* 3.2 3.3 3.5 3.9 (Range <4.5) 2.8 ( < 4.5 )

Hypertension.
Dyslipidaemia( elevated total or low-density lipoprotein (LDL) cholesterol levels, or low levels of high-density lipoprotein (HDL)

17 November 2021 :Creatinine 128 umol/L ( 45-90) H
My recent blood pressure readings are 142/74 on 14 January 2021//// -116/61 28 March 2021////-128/83 15 April 2021//////129/62 pulse 78 11/11/2021///// 150/80 January 2023////// 160/77 2/3/2023//
11/11/2021 : L ? ( 135-145)///Potassium 4.1 mmol/L ( 3.5-5.2)//
CARDIOLOGY SERVICE WAITEMATA HOSPITAL

I met Dr Scott on 12 July 2022. He referred to the angiogram of 2015 and some recent laboratory tests. “Angiogram 2015: Patent stent left main into proximal and mid LAD. Occluded LAD stent after second diagonal – well collateralised. Ostial occlusion LCx-well collateralised. Mid RCA occlusion. EF 60%. She seems to be relatively stable from a cardiac standpoint currently and tells me that she experiences angina approximately once a month”. He advised that he would schedule another stress echo and subsequent consultation -the previous echo was undertaken in Whangarei in 2015. Scott considered that I was relatively stable from a cardiac viewpoint and took note of the fact that I used nitrolingual spray about once a month in respect of angina. He acknowledged my reluctance to have bypass surgery and advised “though I suspect if there was evidence of deterioration in ventricular function particularly if there was a significant ischaemic burden, she may revisit this idea. Her blood pressure today was 140/80 and her pulse regular at around 80 bpm. Her lipids are reasonable but not optimal with an LDL of 2.3. (The LDL was within the normal range (<3.4). She seemed a little reluctant when I suggested increasing her atorvastatin to 80 mg however the other option would be to add ezetimibe 10 mg. I think this would be likely to drop her LDL significantly below 2”.)

Dr Tony Scott
Cardiologist/Physician
A stress echo test was performed 31 October 2022 .

EXERCISE STRESS ECHOCARDIOGRAM Report

Baseline akinetic basal-mid inferior, inferolateral segments; with hypokinetic mid-apical inferoseptum, anteroseptum; exercise stress was submaximal, but nevertheless, there may be increased hypokinesis in the mid-apical anteroseptum, but the basal-mid inferolateral and inferior segments remain similar post stress. Note that the basal inferior and mid inferolateral segments are slightly aneurysmal.

1. LV normal size, systolic function. LVEF 55-60%, with GLS -18%. Mild diastolic dysfunction.
2. RV normal size, systolic function. No Doppler estimation of PASP obtainable.
3. Normal LA and RA size
4. Trivial MR
5. No AS, trivial AR
6. Trivial TR, no PR
7. Normal aortic dimensions.

Stress Results
Protocol: Cornell ESE Maximum Predicted HR: 147 bpm
Target HR: 125 bpm % Maximum Predicted HR: 73 %

                                                              Maximum Stress HR: 107 bpm *METS: 3

Stress Findings: Normal baseline electrocardiogram. There was a maximum .5 mm ST segment depression in the lateral lead(s). Target Heart Rate was not achieved due to leg pain.

Left Ventricle: The left ventricle is normal in size. LVEDD is 4.2 cm. Estimated ejection Fraction is 55-60 0/0. Normal Global
Longitudinal Strain ( 18%). There are regional wall motion abnormalities as specified.

Right Ventricle: The right ventricle is normal size. The right ventricular systolic function is normal. RVS’ is normal ( 10cm/s). TAPSE 2.6cm.

Atria:The Interatrial septum is not well visualised. The left atrial size is normal. LA volume indexed to BSA 33 mls/m A 2. Right atrial size is normal. The right atrial volume is 21 mls.

Mitral Valve: The mitral valve is normal in structure and function. Calcified mitral apparatus. There is no mitral valve stenosis. There is trivial mitral regurgitation.
Tricuspid Valve: The tricuspid valve is normal in structure and function. There is no tricuspid stenosis. There is trivial tricuspid regurgitation
Aortic Valve: The aortic valve is trileaflet. The aortic valve opens well. No hemodynamically significant valvular aortic stenosis. Aortic valve peak velocity is 132.8 cm/sec. Trivial aortic regurgitation.
Pulmonic Valve : The pulmonic valve leaflets are thin and pliable; valve motion is normal. There is no pulmonic valvular stenosis. Trivial pulmonic valvular regurgitation.
Vessels: Aortic sinus size is normal ( 33 mm). The ascending aorta is normal size ( 3.4cm).
Pericardium : There is no pericardial effusion
Diastology: Mitral inflow Doppler reveals E/A reversal, E/A ratio is 0.72 . E/e’ using the septal velocity is 9.2. E/e’ using the lateral velocity is 7.1. E/e’ using an average of lateral and septal velocities is 8. Pulmonary venous flow pattern is systolic-dominant . Physician: DR ANDREW TO 31//0/2022
Ordering Physician: Dr TONY SCOTT 31/10/2022
performed By: BURKE (SONOGRAPHER), COLIN
Name: WILSON, VICKI JOSEPHINE study Date: 31/10/2022 09:08 a.m. MRN: GRD8664

Print Cover I 1
Exercise ECG Report Waitemata DHB
Patient
First Name VICKI Date Performed 31-10-2022
Last Name WILSON Time Performed
Pat ID GRD8664 Tech Marion Buckley
Date of Birth 2-7-1949 Req Provider Dr A Scott
Gender Female Reading MD Rachel Waters RN
Race 11 Account #

ETV Observations: Cornell Exercise time: 03:41 Target HR NOT achieved: , ST Changes: Downsloping ST depression V5-V6 and inferior leads in stage 2 of exerciser Arrhythmia: nil, BP Response: Appropriate, Other: Leads as per ESE placement. See echo report. Denied any CP or dizziness throughout. Registrar present for test.

RN Rachel Waters

Visit Date: 07/03/2023

Cardiology Clinic Letter

Dear Dr Thorpe

Re WILSON, Vicki – dob 2/07/1949 (Female) NHI GRD 8664 Flat 7/36 Taharoto Road, Takapuna, Auckland 0622

Medical Problems:

1. Right carotid bruit.
   • Awaiting carotid ultrasound.
2. Ischaemic heart disease.
   • ESE 31/10/2022: Baseline akinetic basal-mid inferior, inferolateral segments. Hypokinesis of mid apical inferosep-tum, and septum. Submaximal exercise however evidence of potential ischaemia in mid apical anteroseptal. EF 55-60%. Normal RV size and function. No significant valvular lesions.
   • Angiogram 2015: Patent stent left main into proximal and mid LAD. Occluded LAD stent after second diagonal – well collateralised. Ostial occlusion LCx-well collateralised. Mid RCA occlusion. EF 60%. No good percutaneous options (Tim Glenie). Bypass surgery discussed but patient not keen.
3. Previous mild renal impairment normal currently.
   • Creatinine 81, mild hyponatraemia sodium 134 (5/5/22).
   • Hyponatraemia-sodium 129, creatinine 113, eGFR 42 (11/11/21).
4. Hypertension.
5. Dyslipidaemia.
   • Total cholesterol 4.3 mmol/L, TG 2.4, HDL 1.11, LDL 2.3 (non-fasting 5/5/22).
6. Fibroadenoma of the breast.
7. Previous hysterectomy/oophorectomy.
8. Previous bleeding duodenal ulcer.
9. Previous Graves’ disease.
10. Distant ex-smoker.

Current Medication:

1. Cilazapril 5 mg daily.
2. Aspirin 100 mg daily.
3. Bendrofluazide 2.5 mg daily.
4. Omeprazole 40 mg daily.
5. Carbimazole 5 mg twice daily.
6. Amitriptyline 20 mg daily.

WILSON, Vicki Page 2 of 2

7. Atorvastatin 40 mg daily.
8. Nitrolingual spray as needed.
9. Respigen inhaler.

I met with Vicki today in followup. Her stress echo was technically challenging judging by the report however there is a sugges-tion of ischaemia in the distal LAD territory. Overall LV function was relatively normal however though wall motion abnormali-ties are seen, as detailed above.

In discussion with her, she does have chest discomfort from time to time but she believes some of it at least relates to her ongoing chronic lung problems which she attributes to infection. It does not sound particularly exertional in nature. She uses the Nitrolin-gual spray intermittently she tells me.

She is not particularly keen on considering bypass surgery and would like to pursue the possibility of further stents. I think that is unlikely but will discuss it with my interventional colleagues again.

She also has found that her blood pressure is quite variable with some quite high values at times. In clinic today however it was not too bad at 136/68 mmHg. Cilazapril will be discontinued later this year and I have given her a prescription for lisinopril 10 mg daily as an alternative.

She has a right carotid bruit which is quite high-pitched and mid systolic. It does not seem to be a transmitted murmur. She is concerned that there may have been progression of changes that she recalls from Doppler investigation in the early 2000 and I will place a referral in our system. She tells me that she was reviewed by Dr Willoughby, neurologist, around 2015 and the possi-bility of a recent TIA was raised at that time. I cannot see that an ultrasound has been done at that point though a cerebral MRI was undertaken. The changes noted appear to be non-specific and do not indicate previous occult strokes.

She is concerned that she currently has a chest infection which is causing her some problems. She describes some yellow sputum intermittently as well as discomfort across the inframammary region. Her chest however is quite resonant and clear on ausculta-tion currently. She is concerned that she has a chronic pseudomonas infection and tells me that she is due to see Dr Sood in the Respiratory Clinic over the next month or two.

I will comment further after reviewing her coronary angiogram and her carotid ultrasound will come to you as well (see subse-quent letter).

Yours sincerely
Electronically sighted and approved by

Dr Tony Scott
Cardiologist/Physician

NHI: GRD8664
Date: 22/03/2023
Takapuna
Auckland 0622
Cardiology Non-Contact Letter

To: Dr Audrey K Thorpe, 16/326 Sunset Road, Mairangi Bay, Auckland 0632 cc: Ms Vicki Wilson, Flat 7/36 Taharoto Road, Takapuna, Auckland 0622

Dear Dr Thorpe

Following Vicki’s clinic visit earlier this month, I have now had an opportunity to review her previous angiogram from 2015 with one of my interventional colleagues (SEJ).

There is significant obstructive disease with a long LAD stent which is now occluded and a an occlusion of her mid RCA. There is also occlusion of her mid circumflex which is a relatively small vessel. There is no option to open any of these occlusions and revascularisation of these territories would require bypass surgery. She does have moderately severe disease in a relatively large ramus intermedius branch which could potentially be stented. We would only proceed in that direction however as a palliative measure if she had significant chest discomfort which was not manageable by medical means.

She is currently awaiting a stress echocardiogram in order to assess her overall LV function and potential ischaemic burden. I will plan to see her again and comment once this is done. When I saw her, she only occasionally had chest discomfort. If this changes however, please contact me and I will accelerate the process.

Yours sincerely
Electronically sighted and approved by
Dr Tony Scott
Cardiologist/Physician

NHI: GRD8664
Date: 31/03/2023
Cardiology Non-Contact Letter

To: Dr Audrey K Thorpe, 16/326 Sunset Road, Mairangi Bay, Auckland 0632 cc: Ms Vicki Wilson, Flat 7/36 Taharoto Road, Takapuna, Auckland 0622

Dear Dr Thorpe
Subsequent to my earlier communications regarding Vicki’s coronary disease, I have reviewed her previous stress echocardio-gram again.

The test was a little suboptimal as she did not reach target heart rate due to leg discomfort. I think if we are to repeat an ischaem-ic assessment, an alternative modality would be more appropriate. Ideally, I think this would be an adenosine sestamibi scan. However, this is not currently available in the Auckland region.

As she is not on a beta-blocker, a dobutamine stress echocardiogram could also be considered.

In the meantime, I will arrange to see her later this year as her symptoms are relatively stable and not limiting at this point. If, however, this situation changes and she has more progressive ischaemic sounding chest discomfort on exertion, then this could be reviewed and we may consider revascularisation. I would emphasise, however, that this would be symptom driven/palliative, given that we cannot address all potential ischaemic sites with percutaneous intervention alone.

Yours sincerely
Electronically sighted and approved by
Dr Tony Scott
Cardiologist/Physician

DERMATOLOGY
In November 2001 I was afflicted with a bad attack of shingles on the back and extending arought chest wall. I was also diagnosed with bacterial infection Pseudomonas Aeruginosa that same year. Zovirax treatment was prescribed. On 17 January 2008 I attended Dr Baker at Molecheck for a consultation. Their report advised “ that dermoscopy of all pigmented lesions was normal apart from a lesion on her left mid abdomen slightly raised 6 x 3 mm in size suspicious of a BCC. She also has a large 1 cm raised round pink lesion on her right forearm tha she is convinced is a BCC and although it has a wobble sign and is diffusely pink with no real features it does have some slightly arborizing vessels and should also be excised. Digital dermoscopic imaging was not required. I treated a large number of seborrhoeic keratoses with cryosurgery. I have asked her to arrange for the excision of the 2 lesions. I have circled the abd lesion”.
On February 13 February 2009.I attended Auckland Dermatology clinic. I explained that in 2002 a clinical Professor of Surgery and Dermatology James Shaw had diagnosed the condition as a “basal cell carcinoma BCC on the forearm proximally”.( I have a long history of sun exposure and two incidents of severe sunburn) The registrar Dr Wong claimed not to be familiar with the professor. He assessed the growth as a “soft fluctuant nodule that was fairly mobile…clincally it did not look like a carcinoma as it was too soft…BCC is normally solid.” The Consultant Dermatologist Dr F Oliver agreed that “this was not a basal cell carcinoma and was more likely to be a benign neurofibroma. The differential diagnosis was a dermal naevus. We have reassured her that no further intervention is necessary for this benign lesion”
In February 2011 Molemap diagnosed a significant number of kerastoses including black keratoses as “benign lesions” In July 2011 the ADHB Registrar Dr Simpkin in conjunction with a consultant dermatologist Dr Lamb examined the numerous keratoses-their report is as follows: “On examination today I performed a full skin check. She has multiple sebhorreic keratoses and one of concern to her was a large dark sebhorreic keratoses that under dermoscopy had typical appearances including milia –like cysts, crypts with keratin and only one uniform colour and is stuck on appearance with multiple other sebhorrreic keratsoses which appeared similar. She also had a sebhorreic keratosis behind the right ear. She had a soft 1.5 pink nodule on the right forearm which under dermoscopy has no concerning feature. She has also been reviewed by the dermatologist who agrees the nodule on the right forearm is a neurofibroma and the lesion on the back is a sebhorreic keratoses. Both of these lesions and benign and do not require excision but if the patient is wanting them to be excised she could approach a general practitioner . We have not made further arrangements to see this patient again”
My own observation of the dark kerastosis from a dermascopic photo was that it measured approximately 10 mm was slightly irregular with color ranging from dark brown tinged with dark yellow near the edge with a pink pigmentation extending out from the extremities.
I again visited Molemap in January 2012 for the cryosurgical removal of a large number of lesions. Dr Langford reported that “ dermoscopy of all pigmented lesions was normal. Digital deromscopic imaging was not required. I treated multiple serorrhoeic keratoses with cryosurgery. …will require further treatments to totally eliminate the seborrhoeic keratoses.”
There seemed to be difference of opinion between Molecheck and ADHB’S Dermatology concerning the removal of the two lesions. Although a lesion on the abdomen “ suspicious of a bcc” was specified by Molecheck it was not reported on by the dermatology clinic. Likewise while the dark keratosis was assessed by Dermatology and photographed by both Molemap and Molecheck identifying characteristics were not specified by either of the latter .It is of some concern that no follow-up consultations were recommended for the future particularly by public hospital.
A large number of kerastoses were removed by cryosurgery performed by Dr Cottee of Whangarei in September 2014. In lieu of a consultative report I received a basic summary of Dr Cottee’s consultation notes as provided by his secretary:
“Hi Vicki,As per our conversation today I include Dr. Cottees consult notes for 1 Sept 2014 as requested by you. EnidTown Basin Specialist Centre
“ BJC – full general skin check done///Lots of Seb Keratoses on back and abdo and arms and legs Cryo done AK R leg cryo done x3 AK L leg cryo. done x 4 AK R arm cryo done x3 AK abdom cryo done x 16 AK back cryo done x 40
Lesion on R forearm – a 3 cm dia lesion that has ben present a long time and ? growing – ? cong nevus ? to remove”.
A request for a consultation at the Dermatology Clinic was sent by GP Dr Thorpe on 25 September 2020. She had photographed images of lesions on my back and hand which she advised would also be onforwarded to the Clinic. I contacted a scheduler at the clinic who advised that the request for a consultation had been denied and a letter had been sent to my general practitioner. However I have not received any such advice from the clinic. In the interim I emailed further images and reports to Dr Wood of the clinic however I did not receive an acknowledgment of a receipt of the email and subsequently received a referral from Waitemata DHB to the dermatology practice of Dr Coe of Devonport on 30 November 2020. Coe photographed my bamber of moles and a few kerastoses. One kerastosis in particular has been removed on three previous occasions but since returned There were no additional dermoscopic photos taken. A diagnosis of kerastoses was made on the basis of the one photo. Removal of the lesions was not provided as a free service by the practice to patients referred by public health. The duration of the consultation was about 10 minutes and there was no further advice from Coe.
A number of kerastoses and skin tags have been removed from Torbay Skin since 2021. On 5 October 2022 I visited Skincheck of Northcote where 3 probable cancers -2 probable BCC (basal cell carcinomas) and one probable squamous nodular carcinoma were excised prior to analysis at the anatomical laboratory.
Specimen Part 1/3
SKIN LESION LEFT FOREARM
Gross description: skin ellipse 44 x 5 x 2 mm with a central slight raised lesion measuring 9 x 4 x1 mm. Margins inked blue. Tranversely sectioned. Microscopy sections show skin to subcutis.There is a nodular basal cell carcinoma. There is no perineural invasion. BASAL CELL CARCINOMA COMPLETELY EXCISED.
Specimen . Part 2/3
SKIN LESION RIGHT MIDBACK
Gross Description. Skin ellipse 24 x 11 x 5 mm with an eccentric raised lesion measuring 10 x 6 x 2 mm. Margins inked blue. Transversely sectioned. Microscopy Skin with a neurofibroma completely excised. Overlying it there is a seborrheic keratosis which extends to radial margin. NEUROFIBROMA SEBORRHEIC KERATOSIS

Specimen . Part 3/3
SKIN LESION LEFT THIGH
Gross Description. Skin ellipse 50 x 20 x 5 mm with a central scaly raised lesion measuring 14 x 10 x 6 mm. Margins inked blue. Transversely sectioned. Microscopy INFLAMMED REGRESSING WART CLEAR MARGINS

Reported by Dr Dennis Kee Anatomical Pathologist Anatomic Pathology Service, Mount Wellington
Ordered by Michael Zheng 5 October 2022

Dr Zheng had originally assessed the lesion on the left thigh as a nodular squamous carcinoma . A second opinion has been requested by my GP.
I emailed Dr MacGill images of my excisons including a Dermnet NZ image of a nodular squamous carcinoma which appeared similar to the lesion excised on my thigh. His reply dated 29 November 2022 is detailed below:
On 29 November 2022 I received a reply from Dr Macgill of Skincheck.

“Hello Vicki
Thanks for your email. I have reviewed your case ( the imges and histology report). I noted Michael has requested the lab have a further look at the specimen. Keratotic lesions, clinically and dermatoscopcally, can be difficult to differentiate. Your lesion had many features of an SCC but tis can occur with viral warts, and the histological diagnosis is the gold standard. I agree with Michael it is worth asking the pathologist to review the case. Regardless, the lesion( whatever the final diagnosis ) has been completely removed and no further treatment is necessary .
I hope this helps Kind regards Andrew Macgill”

The excisions were undertaken on 5 October 2022. In October 2022 Dr Zheng advised by phone that he was satisfied with the diagnosis of a regressive wart.! On 4 December he advised that there had been a revised diagnosis of a Keratoacanthoma. The revised diagnosis is detailed below. It isn’t entirely clear as to what length of time a specimen is retained at the laboratory as the original diagnosis was made 2 months ago.

SpecimenSpecimen. Part3/3
SKIN LESION LEFT THIGH
Gross Description.
Skin ellipse 50 x 20 x 5 mm with a central scaly raise lesion measuring 14 x 10 x 6 mm. Margins inked blue. Transversely sectioned.
Microscopy.
Deeper levels were cut and examined following the request from clinician to review the case. The initial diagnosis signed out was a wart. The deeper levels continue to show a benign verrucal keratotic lesion with bland epithelium which is not compatible with squamous carcinoma but the lesion has more of a crater shape arrangement on the deeper levels which will fit with a partially regressed keratoacanthoma. A total of six deeper levels were examined.
KERATOACANTHOMA CLEAR ‘MARGINS
Reported by Dr Dennis Kee
Anatomical Pathologist
DERMNET ADVISES:
Keratoacanthoma (KA) is a common, rapidly growing, locally destructive skin tumour. KAs may regress spontaneously with scarring, but clinically they may be indistinguishable from well-differentiated squamous cell carcinoma (SCC) and the clinical course may be unpredictable. Thus, many clinicians and pathologists prefer the term SCC, KA-type and recommend surgical excision.
Keratoacanthoma is most common in fair-skinned older males with a history of chronic sun exposure. Most patients are over 60 years of age and it is twice as common in males than in females. The incidence rate in Queensland, Australia is 409/100,000 person-years. Keratoacanthomas typically present as a solitary, rapidly growing nodule on sun-exposed skin of the face and upper limbs. Keratoacanthomas are sharply demarcated, firm, erythematous or skin-coloured, with a classic cen-tral hyperkeratotic plug and an even shoulder. Removal of the keratotic core will leave a ‘crater’-like appearance to the lesion. Keratoacanthomas must be distinguished from well-differentiated SCC. Other differential diagnoses include: Amelanot-ic melanoma/////Nodular basal cell carcinoma///Common warts////Giant molluscum contagiosum///Metastatic deposit ////
SQUAMOUS CELL CANCER-
Distinct clinical types of invasive cutaneous SCC include:
• Cutaneous horn — the horn is due to excessive production of keratin
• Keratoacanthoma (KA) — a rapidly growing keratinising nodule that may resolve without treatment
• Carcinoma cuniculatum (‘verrucous carcinoma’), a slow-growing, warty tumour on the sole of the foot
• Marjolin ulcer – a cutaneous SCC that has developed in a scar or chronic ulcer
• Multiple eruptive SCC/KA-like lesions arising in syndromes, such as multiple self-healing squamous epitheliomas of Ferguson-Smith and Grzybowski syndrome.

Squamous cell carcinoma (SCC) is the second most common form of skin cancer. It’s usually found on areas of the body damaged by UV rays from the sun or tanning beds. Sun-exposed skin includes the head, neck, chest, upper back, ears, lips, arms, legs, and hands.
SCC is a fairly slow-growing skin cancer. Unlike other types of skin cancer, it can spread to the tissues, bones, and nearby lymph nodes, where it may become hard to treat. When caught early, it’s easy to treat
Squamous Cell Carcinoma Symptoms: SCC can show up as A dome-shaped bump that looks like a wart//////A red, scaly patch of skin that’s rough and crusty and bleeds easily/////////An open sore that doesn’t heal completely////////// A growth with raised edges and a lower area in the middle that might bleed or itch

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GENERAL PRACTITIONERS
Subsequent to the departure of Dr Harries from Maheke Medical Centre circa 1999 I have found the standard of medical care to be cursory and non-investigative. Dr Harries successsor was Dr Crombie . I left the Maheke practice and since then I had been receiving most of my treatment from either Eastridge Clinic. As a result of sputum tests undertaken by Bay care a diagnoses of gram negative Pseudomonas aeruginosa and gram positive cocci were made in March and December 2003 respectively. I have also attended at the White Cross Clinic Remuera and City Med Clinics.
In 2002 I attended Dr Jane Buckley at Remuera Rd. She was quite helpful in some respects and provided me with a spacer for my inhaler. However, with regard to heart matters she advised that my BP was normal and that any further heart checks were not necessary regardless of the fact that there is a history of heart disease in the family -my father died at Greenlane Hospital in 1997 after his second bypass operation. I smoked for 20 years and have a long history of chest and sinus infections. A cholesterol test indicated a total level of 5.9- ( ratio 3.5) Ms Buckley highlighted the test with a notation “lots of good cholesterol”. A level between 5 and 6.5 is normally considered borderline and certainly not good.
I subsequently selected Dr Tom Marshall OBE and Chairman of Procare . He spent about a half hour taking details of my medical history. He was blatantly sceptical of my complaint of any ongoing bacterial infection( pseudomonas) advising that 6 months hence I would be unlikely to be still infected. He suggested that I might need to see the pain clinic . He refused to prescribe and suggested that I would be better off consulting a GP in St Heliers. He then aborted the consultation. An Encarta Website which details the investigation of a bacteriologist from Wisconsin describes Pseudomonas Aueriginosa as a “fearful antibiotic resistant gram negative bacteria “ with many side effects including brain lesions, meningitis, septiceamia , damage to heart valves and eyes”
On 12 December 2003 I visited GP Dr Lyn Graham at White Cross Remuera. I showed her copies of my thermography report , the results of the lab sputum tests and I also provided samples of my recent yellow coloured sputum on tissues.Ms Graham referred to the laboratory report which advised that only a small number of cocci were evident and on that basis declined to prescribe. She felt that I should once again visit my specialist for any further treatment.
On Saturday 13 December 2003 I visited Dr Stoyanoff at Baycare Eastridge. Stoyanoff expressed little interest in the thermography and Pseudomonas reports ( the latter was copied from an Encarta website). He prescribed Erothromycin at my request , but was unable to oblige with regard to medication for the discomfort in the upper abdomen. No explanation given.
In the intervening year I have consulted 2-3 different GPs at CityMed in the city.On one occasion Dr Knill flatly refused to prescribe antibiotics-he subsequently telephoned me the same afternoon and advised that he had changed his mind and would be sending a prescription in the mail. On another occasion the attitude of Dr Megan Corbett left a lot to be desired. When discussing the merits of an antibiotic prescription she rather spitefully stated “that if her daughter was coughing up green stuff she wouldn’t prescribe antibiotics” However, on a previous occasion she advised that she had noticed “crackles” in the left side of my chest Dr Ian McDonald at Eastridge thought that he detected a “dullness “on the left side of the chest as opposed to the right. .
On 28 October 2004 I was prescribed additional antibiotics namely Augmentin and Cotrimoxazole by Dr Hancock of Citimed. I have only recently completed a course of Augmentin and doxycyclin and as at 31 October I am still producing small amounts of gold coloured sputum from the chest. In the past Dr Hancock has seen fit to take my blood pressure however this was omitted on the two previous visits –likewise a stethoscope /chest check has never been attempted by her .
As at 25 November 2004 later I am still experiencing discomfort in the left side of the chest and still producing coloured sputum from lungs and to a lesser extent also nasal sputum reports. In December 2004 sputum samples have ranged from rust-coloured (possibly symptomatic of bleeding)to yellow coloured. There is also continuing discomfort in the left side of the chest including occasional minor sharp pains together with severe inflammation in the sinuses and head /neck area.
I re-visited Dr Hancock on 16 December 2004-she could find nothing significantly wrong after checking my chest and my blood pressure was reasonably normal. A peak flow test was also undertaken and 10 Romicin tabs prescribed. ( I had previously been prescribed large number of Co-Trimoxazole and Augmentin tabs) When I mentioned that RBCs had not been reported by the laboratory since 1999 Dr Hancock advised that “it was probably due to a different style of reporting”! A spirometry test undertaken by Dr Hancock on 16 December 2004 indicated a level 350 while a check of the chest indicated no significant abnormality. . I was prescribed a further 10 Romicin tabs – As at 21 December I am experiencing severe discomfort particularly in the lower left chest extending into the back and also afflicting the sinuses head and neck. The chest discomfort is more pronounced after coughing,
On 22 December 2004 Dr Bhai of Glen Innes claimed that he was unable to detect any significant abnormalities in the chest apart from impaired breathing. While he appeared interested in the fact that I had been infected with Pseudomonas Aeruginosa in the past he expressed a lack of concern when I mentioned that I had also experienced discomfort in the glands in the neck. He prescribed augmentin and lora tabs for allergy.
On 26 January 2005 I attended Dr Crozier at Baycare Eastridge . He was quite happy to prescribe Romicin tabs ( 300 mg) for an extended period. He undertook a stethoscope check of the chest and a finger check of oxygen levels which was apparently recorded at 98%. When I suggested a spirometry test he declined as he felt that the latter test was the better option. I have never been given an oxygen test involving the finger at any other medical practice including specialists –all tests have have either spirometry or stethoscope. A spirometry test instigated by another Baycare doctor some years ago ( recorded a level of 340 ) resulted in my being prescribed an inhaler . More recently it was 350. For somebody of my height the normal level would be approximately 450.
In March 2005 I attended Dr McDonald of Eastridge. He provided a prescription of Augmentin tabs. He said that a check with the stethoscope revealed nothing untoward however as at 15 March I am producing some faintly yellow coloured sputum and have quite noticeable discomfort in the centre of the chest and sinuses /head. He also provided a prescription for anti-fungal sporanox tabs for thrush. A new prescription for augmentin was provided on 4 april 2005 I was once again prescribed augmentin tabs for on-going chest infection. Dr McDonald checked the chest with the stethoscope and found nothing significant –he seemed a little confused as to my previous history of chest infections ( I have also complained of severe inflammation in the sinuses and head generally)
The spriometry test was much higher than usual in the 400 range. A follow-up consultation in early May resulted in a prescription for Romicin . A sputum was also provided for onforwarding to Southern Community Labs.( See Respiratory notes)
A sputum test of 4 April reported a small number of white cells –moderate number of epithelial cells –mixed bacterial flora and the usual oropharyngeal flora. Culture showed a heavy growth of serratia marcescens which is apparently sensitive to cotrimoxazole and ciprofloxacin. Dr Hancock has prescribed cotrimoxazole
“Cephalosporins, gentamicin, amikacin are also recommended. Tests have shown marcescens to be dominant over the B cereus, subtillus, E coli, S lutea and B megaterium. This bacteria is a gram negative.-a human pathogen of the family enterobacteriaceae. It is involved in noscomial infections particularly urinary tract infections and wound infections. Most strains are resistant to several antibiotics because of the presence of R-factors on plasmids. It occurs naturally in soil and water as well as the intestines. Its often associated with endocarditis, osteomyelitis, septicemia, wound infections, eye infections and meningitis”.
(In an experiment conducted by the US Army in the 1950s balloons were filled with Serratia marcescens and burst over the city of San Francisco Shortly thereafter doctors noted a drastic increase in pneumonia and urinary tract infections.)
In 2 subsequent May 2005 consultations with Dr McDonald I have been prescribed ciprofloxacin and Co-trimoxazole and augmentin. Dr McDonald was initially very reluctant to prescribe any alternative antibiotics until the results of the latest sputum test became available. This was despite the fact that my sputum sample was much the same as previous specimens and 2 of the drugs recommended for treatment by Medlab were Co-Trimoxazole and /or Cipro. My experience is that Cipro is the least effective of all the drugs. McDonald suggested “ that I was coming in with bits of paper and asking for this that and the other drug-and that it was negligent for him to keep prescribing” An illogical statement. As I explained I have a history of 20s+ years of chest and sinus infections-the bacteria are a combination of dangerous gram negative and gram positive-and notorious for their drug resistance. I suggested a combination of existing drugs or even a larger dosage-while the drugs no longer totally eliminate the infection they can ameliorate many of the symptoms. McDonald still felt that I should consult a specialist and possibly have a chest x-ray or Ct scan of the chest. He is aware that I have already consulted 3 respiratory physicians with no result.
A sputum sample sent by Dr McDonald in early May to Southern Commnity Laboratories reported the presence of : “a small number of polymorphs,moderate numbers of epithelial cells large numbers lf gram negative bacilli and large numbers of gram positive cocci”. I requested and was prescribed Romicin antibiotics. Some wheezing was detected in the left lung . I have been prescribed co-trimoxazole , augmentiin Romicin and Ciprofloxacin. As at 24 May I am still badly affected in the lungs and with accompanying serious inflammation in the sinuses and head.
Diagnostic Laboratory’s sputum report dated 24 May reported a “ small number of white cells and mixed bacterial flora” As at 10 June 2005 I am still experiencing quite severe symptoms including pains in the lower chest soreness in the centre of the chest and inflammation which is particularly severe in the legs and feet making walking difficult. I have almost completed a course of augmentin and co-trimoxazole.
During a visit to Dr Julie Hancock at Citymed on 16 June 2005 she refused to prescribe any further antibiotics –and claimed that the 2 most recent sputum tests indicated nothing of significance. We had a difference of opinion on the subject . ( Medlab test of April 05 diagnosed Serratia Marcescens and the lab test of 3 May reported large numbers of gram negative bacilli and gram positive cocci) I mentioned that Serratia Marcescens had been used for experimental purposes by the US Army in the 1950s over San Francisco- there was no response from Hancock ! She did however prescribe a nasal spray Butacort a Pulmicort inhaler.and paradex tablets as a substitute for antibiotics/panadol. ‘She also requested a blood test –ESR. ( Note: Shortly after I left Hancock’s room there was a loud comment called out –possibly from Hancocks room –her door was closed –namely “ she won’t be back here again”)
I subsequently received a copy of a Pelvic scan report undertaken at Green Lane on 22 February 2005.which was sent to me in the mail at my request by one of Citymed’s nurses. Although I had a consultation with Dr Hancock the previous week the scan was never mentioned by her. Dr Hancock has a Dip Obs. Qualification.
On 14 July 2005 I consulted Dr Kala at East Tamaki Healthcare. She was unfortunately initially very resistant to prescribing antibiotics –citing the most recent sputum test in which no pathogen was specified. I showed her excerpts from my respiratory file including the diagnosis of serratia marcescens in April of this year -I mentioned that the bacteria was implicated in the contamination of the US 2004 flu vaccine however she chose to ignore that aspect . She did specify that my breathing was a little laboured and was recommending only cough syrup and possibly losec. She finally requested a second opinion from Dr Yee and he suggested that antibiotics might be in order and I was given a prescription for co-trimoxazole. Dr Kala was citing the fact that I was only a casual patient and as such they didn’t have access to Ct scans etc and recommended that if I was experiencing discomfort in the chest I should attempt to do something about it other than simply requesting antibiotics. I explained that I had already consulted 3 chest physicians and had undergone a bronchoscopy.
On 7 August 2005. I was further prescribed a 2 week course of augmentin, and at my request, a prescription for lipex from Dr Muller of East Tamaki Medical. Dr Muller checked my chest with a stethoscope and claimed he couldn’t find anything untoward apart from a “rasping?” sound. . He was unable to locate any previous details about previous infections even though I had shown Dr Kala copies of my previous recent lab /sputum tests. When I mentioned that I had been recently afflicted with serratia marcescens Dr Muller appeared to be confused concerning this particular medical condition and did not comment on specifics pertaining to the serratia strains although he seemed to take note of the fact that pseudomonas had also been diagnosed in the past.
A consultation with Dr David Chee at East Tamaki Healthcare on 7 September 05 resulted in a prescription for 20 Romicin tablets. The nurse had previously taken my blood pressure -140/90 which only received a brief mention by Chee after I brought it to his attention.. A stethoscope examination of my chest revealed “ nothing of significance” . Although I requested a peak flow test this was not done.
I attended the Southern Cross clinic on 23 September 2005. I had already been waiting for approx 1-1 ½ hours, and another ½ hr to ¾ hr period elapsed subsequent to the apparent departure of the last patient. I enquired from the receptionist as to the next appointment –she advised that the doctor was taking out stitches. The duty doctor was a young Indian woman. I walked past her office and she was busy using her word processor. She advised “ that she didn’t know when the next appointment might eventuate as she had a patient to attend to”. I departed soon afterwards without a consultation. .
Antibiotics were denied by Dr Crozier at at consultation on 25 September at Eastridge. He felt he was unable to assist-he would need to see evidence of infection – and it was a matter for either a GP or a specialist. I explained that I did not have a GP at the present time and had been to the Eastridge Clinic many times over the years and that the clinic retained all my particulars and details of chest infections. Also Dr Crozier had no such reservations when he prescribed antibiotics in January of this year. When I mentioned that my recent BP tests were 140/150 /90 he suggested that he might “ get the nurse to check” –however that did not eventuate. The consultation ended after about 10 minutes.
There was a consultation with Dr Coral Fonseca of East Tamaki Healthcare in Glen Innes on 5 November 2005. I had been experiencing fairly severe pain in both the sinuses and neck area. I produced some nasal sputum which although predominantly white in colour did contain significant flecks of yellowish/green sputum. Dr Fonseca claimed that checks of my chest and glands revealed nothing untoward and she contended that that I was afflicted with nothing more than routine hayfever.. I disagreed and reiterated that after 30 years of experiencing severe chest and sinus infections I should be able to tell the difference between allergy and the onset of infection. Fonseca then made a rather extraordinary statement “that if you have been taking antibiotics for 30 years without any significant improvement what then is the point of taking any more” When I advised that my history included having been afflicted with assorted gram negative infections and having almost been hospitalized on one occasion a few years ago she claimed that there was no evidence of those details on the computer . I advised that doctors had been advised of those details during previous consultations and they should most certainly be on the computer. I told Dr Fonseca that I was dissatisfied with her prescription of allergy medication only and ended the consultation.
A Sputum/gram stain test of 16 November 2005 indicated a large number of white cells , no epithelial cells and mixed bacterial flora together with a moderated growth of normal respiratory flora. I was prescribed a course of Augmentin . Dr Thomson enquired as to whether my sputum was fairly typical ( frothy?) and whether I had ever had TB. I explained that I had been tested for Tb at my request a few years ago and it was negative. I explained that I thought there was a slight muscular weakness in the left lower arm –however Dr Thomson made no comment after testing.
A prescription for Augmentin and Co-Trimoxazole were prescribed by Specialist Dr Orr-Walker on 21 March 06.
A consultation with Dr Martin Thomson of Eastbay Medical Centre on 17 November 2005 resulted in a prescription of augmentin together with eye drops and inhalers. I provided a sputum sample and Thompson commented on the of the latter and enquired as to whether this was the norm . ( My sputum was also very frothy which can be indicative of Pneumonia or Pleurisy ) I advised that this virtually the case. Apart from that he made no other comment. He also asked whether I had ever visited Africa ( presumably in response to my advice that I had been afflicted with Pseudomonas Aeruginosa in the past) and whether I had ever been afflicted with Tb. I advised that I had a skin test for Tb some years ago and there was no indication of the disease. He checked my chest and made no comment. He declined to look at my file suggesting that it might be more appropriate next time. ( He is a locum –standing in for Dr Lyn Henrys on Wednesday of every week). Medlab results indicated large number of white cells , no epithelial cells and mixed bacterial flora. The culture specified a moderate growth of normal respiratory flora.
I attended Dr Henrys at Eastbay Medical on 22 December 2005. I once again complained of severe inflammation in the sinuses head and neck area co-inciding with the increasing respiratory discomfort and sputum. She took my temperature and checked my chest without further comment and agreed that if I was experiencing pain then an antibiotic prescription would be in order. I suggested a change to erythromycin and she agreed. She did not check my blood pressure. With my regard to my broken toe she advised that the break would probably take about 3 months to heal and advised me to strap both toes together with cotton wool between. She did not physically check the toe nor she did recommend an x-ray. She had a brief glance at the details on my personal respiratory file and the thermography reports but otherwise made no comment. The consultation did not really lend itself to any further in-depth discussion about any of my other medical concerns. I made only moderate progress on the eryrothmycin and by the end of the course was worsening with significant inflammation in the sinuses frontal lobes and neck together with increasing inflammation in the legs and feet.
I again visited Dr Thomson again on 13 January 2006. He checked my chest by claimed to have detected nothing of significance. I advised that the pain in the sinuses/head and neck was seriously debilitating and at times necessitated use of an ice pack on the head…I advised that I had coughed up a small amount of yellow coloured sputum a couple of days earlier. The mucous is viscous and often hard to dislodge. I explained that I had experienced pains in the lower parts and centre of the chest. When I referred to my previous frothy sputum sample and suggested that it might be suggestive of pleurisy pneumonia or Tb Dr Thomson feigned ignorance of any such diagnosis. (Pleurisy had once been diagnosed by a Wellington GP in the early 1980s)
I advised that I had attended 2 ENT specialists and that I felt that their findings were at variance with the thermography report. I also advised that I wasn’t satisfied with the assessments of the 3 Respiratory Physicians that I had attended either however Thomson queried my scepticism. I suggested a referral to another Chest Physician however this request was not followed up.
With regard to my apparently broken toe Thomson asked me to flex the latter and then provided a referral to radiology. Thomson then provided (inadvertently ) some rather extraordinary data on a referral to Medlab including my BP, weight,usual drug regime- “recent # 6 weeks ago of the 3rd R toe///chest clear sl tender sinusis all over and T 36.6/////prone to recurrent bronchitis cond///and feels need for antibiotic and names it///has control over her own health and carries own file around///ME and a number of ailments and very firm in her ideas” The reference to recurrent bronchitis is erroneous as was a similar reference in a previous report from respiratory physician Dr Garrett subsequent to a bronchoscopy. Once again Thomson declined to look at my file on the grounds that he did not have enough time. If he had done so he would have have found evidence of previous infections such as Pseudomonas aeruginosa and serratia marcescens and reference to a thirty year history of chest and sinus infections coupled with a history of childhood asthma and a 20 year history of smoking. Irrespective that I experience discomfort in the neck he claimed that he could not find anything significantly wrong with the glands. My BP was 138/72. A prescription of Romicin was ultimately prescribed.
On 2 January 2006 I attempted to get an appointment with yet another GP. The receptionist at the practice of Dr Twigg and White at Orakei advised that they were not taking on any new patients. A further attempt at the Auckland Family Practice of Dr S James on 94 Remuera Road resulted in ten minute conversation with the young receptionist as she took down all my personal particulars – she was obviously taking instructions from another female staff member in the background –she then advised me that the initial consultation would cost $116.00 . I concluded the conversation at that point.
I visited Dr Dan Anderson at Baycare White Cross Eastridge on 27 January 2006. He was a young man aged in his 30s. I advised him of my symptoms ie pain in the sinuses head back of the neck and in the centre and lower chest. He duly checked my chest with the stethoscope but could not find anything amiss. He also commented that “ I looked so well”. I showed him some sputum which was mainly white and frothy with some yellowish discolouration. I advised him that a sputum sample had been sent to Medlab earlier in the week and I was awaiting details. He didn’t consider that the sample which he described as a “ yellow productive cough –clammy with aches and pains and photophobia warranted a prescription and advised me to to another sputum test and provided a receptacle. The fact that I have a 30+ year history of chest and sinus infections fell on deaf ears . As I departed the office Anderson passed a remark “ doesn’t like f…king “ . He charged me $40.00 I advised him that his inaction and comment might be regarded as negligence and might ultimately be a matter for either the police or lawyers. He agreed that might be the case but was apparently unconcerned.
On 3 February 2006 I visited Dr Jane Henrys in West Tamaki: I requested antibiotics as treatment for stenotrophomonas maltophilia . Henrys checked by chest and advised that she could not find anything amiss .She also checked my temperature and advised that it was normal. This does rather contradict with the findings of a GP Dr Anderson at Eastridge the previous Sunday who reported “ yellow productive cough feels hot and clammy/pains in the back of the head and neck” Dr Henrys felt that although this particular bacteria was diagnosed it was not necessarily an abnormal bacteria and I would not necessarily be affected by it. She was initially reluctant to prescribe any medication on the grounds “ it might harm me” I replied that this was the third gram negative bacteria that I had been afflicted with over the past few years and if the bacteria was so innocuous why then was there a recommendation by the laboratory for treatment with specific drugs including gentamicin which is normally administered intraveneously in severe cases. …I further advised that in my experience of drugs Augmentin was the most effective drug –that I had found the recommended drug cotrimoxazole ( a generic) to be not especially effective. Dr Henrys reluctantly provided a prescription for Augmentin .
She requested a blood test /CRP and had initially suggested that I should wait for the result before starting on the prescription. I didn’t feel that was necessary as the proof had already been provided in the sputum test and I was also experiencing quite significant pain particularly in the sinuses and neck.
Dr Butterfield of White Cross Ascot provided further prescriptions for Lipek, Diclofenac and Combivent inhalers on 26 May 2006. I advised that I was near the end of a previous antibiotic prescription –he prescribed 14 Romicin tablets. He checked my chest but not my BP. I requested a peak flow meter test and levels of 250 and 300 were indicated. Butterfield made no comment other than to ask me what I thought the levels should be. I had complained of pain and discomfort in both the sinuses and chest however his only recommendation was to see yet another ENT specialist. I reiterated as I do at most consultations that I have been afflicted with various gram-negative strains over the last few years and as stated on the medlab form they are considered to be multi-drug resistant. Dr Orr-Walker had no hesitation in providing me with 3 months supply of antibiotic. Latterly GPs have been either reluctant to prescribe any antibiotics or they prescribe a minimal amount.
As I had been experiencing a very stuffy nose and painful sinuses with the development of a chest infection and severe cough I received a prescription from Dr Retford for ciprofloxacin and Romicin on 19 August 2006
My mother had also been similarly affected. Yellowish coloured sputum was sent for analysis –both tests dated 19 & August reported small numbers of epithelial cells , mixed bacterial flora and heavy growth of normal respiratory flora. Both tests were done 2 days apart however the first test reported no white cells while the second reported large numbers of the same. Dr Retford checked my chest and found evidence of “ crackles” on the left side . She did not however check my blood pressure.
A prescription for Romicin and Co-Trimoxazole Tabs were provided by Dr Chebbi on 12 October 2006.. Dr Chebbi did an oxygen saturation test on the finger- it indicated 97%. At my request a further test was undertaken with a peak flow meter –it registered 300. ( the normal reading for somebody of my height is 450- previous specialist spirometry tests have been classified as low but within the normal range at 340-370).
When I asked Chebbi about the disparity between the 2 different tests he shrugged his shoulders and said he didn’t know.
A consultation with Dr Talbot of White Cross Eastridge resulted in a prescription for augmentin. Bp appeared to relatively normal. Subsequent to a sputum test in Jan 07 which reported Serratia liquefaciens Dr Retford provided a prescription for a combination of Co-trimoxazole and Ciprofloxacin.
I visited Dr Francis at White Cross Eastridge on 2 May 2007. An “assault “ comment was heard from the doctor outside the consulting room. The door remained open for the almost the duration of the consultation. The practice nurse was also overheard commenting as to “ why psychiatrist committed her”. The consultation was unnecessarily protracted-Francis seemed to be little confused as to which cholesterol medication I had been prescribed –he insisted that I had been prescribed Lipitor in the past and I insisted that I had been prescribe the generic Lipex. He finally acknowledged that I had been prescribed Lipex/Simvastatin tabs. He checked my chest and throat and could not find anything significantly amiss He did not check my neck or glands I had been experiencing quite significant soreness and stiffness in the neck. . Regardless he prescribed augmentin tabs together with renewed prescriptions of Lipex and diclofenac. A peak flow meter test indicated a level of 300 which Dr Francis considered to relatively normal.
On 20 July 2007 I again consulted with Dr Suresh Francis an Indian doctor at Eastridge. I also produced a small amount of slightly yellowish coloured sputum. Francis was very resistant to prescribing antibiotics described the sputum sample as “colourless” and insisted I was probably afflicted with a virus. I advised that I had been attending the clinic for about 20 years, had a history of gram negative infections, and had generally been prescribed antibiotics. I have a history of gram negative infections. He reluctantly prescribed augmentin . He also pointed to a notation on the screen that may have indicated that I had contact with Dr Crozier in April. My last consultation with Dr On Crozier was in 2005.
On 3 September 2007 I met Dr Carol Lawton of St Heliers Health Centre in Polygon Road St Heliers. Lawton was quite obliging and prescribed antibiotics and checked my blood pressure. She gave me referrals to a respiratory physician Dr Rea of Manukau. and Dr Bartlett of Epsom. Unfortunately Dr Rea is no longer taking any private patients and the consultation with Dr Bartlett was not a success as he terminated the consultation because he erroneousely considered that I was not prepared to accept his opinion.
There was a consultation with English general practitioner Dr Angela Jacobsen of Selwyn Medical Centre on 8 January 2008. I had brought a number of CT chest scans for discussion however she stated that she was unable to read them and suggested that perhaps I could take the matter up with the radiographers next door. I had expressed concern about a mole on my back which had changed colour and was now black-also a small round pink lump on the right arm. She doubted that the mole was a melanoma but rather a keratosis and referred to the pink lump as a “squigy thing” . In fact the pink lump was diagnosed by Professor J Shaw a few years ago as basal cell carcinoma who advised that the BCC does not normally penetrate beneath the skin and simply increases in size. Jacobsen seemed very reluctant to refer me onto the public health system as she considered that there would be serious delays. I said that obviously if a melanoma was suspected then some priority would be given by the hospital. In 2001 Dermatology Greenlane advised that a melanoma or query melanoma was assessed as a Lesion A+ category. BCC’s on the trunk or limbs were assessed as Lesion A- and were not seen. Dr Jacobsen did however recommend Mole Check on Remuera Road and I made an appointment with them. I had also requested a referral to neurologist Dr Elizabeth Walker . I made the appointment however no referral has as yet been received by the staff at Adventist Hospital. I have twice spoken to the staff at Selwyn Medical- on one occasion Dr Jacobsen was absent and the receptionist put a note in Jacobsen’s diary. On Friday 11 January 2008 Dr Jacobsen had briefly visited the practice however the referral had still not been dealt with.
On 19 March 2008 I consulted Dr Sunil at Eastridge White Cross. He checked the chest with stethoscope ( although not the areas where I experience discomfort namely the centre and left side ). He did not check my throat nor did he take my blood pressure. He made no comment concerning the result of his stethoscope check. He didn’t think I had a temperature and although was prepared to prescribe antibiotics would provide a week’s dosage of augmentin and 30 diclofenac anti-inflammatory tabs. ( I normally receive a prescription for 2 weeks of antibiotics and three months supply of anti-inflammatory tabs).
I met Dr James Dryden on 29 July 2008 as I was once again experiencing flu symptoms. He duly checked my chest with his stethoscope but not the centre of the chest nor the left side where I experience most of my discomfort. I suggested that he undertake a BP test but this request was ignored. ( I have a heart condition) At my request I undertook a peak flow meter reading which indicated a level of 300 . I tried to discuss this with the doctor but was told “ not to worry about it”. ( several years ago another GP from Eastridge initiated a peak flow meter reading and advised that for somebody of my height the norm should be around 450). Spirometry testing by a respiratory physician has indicated a maximum of 370 assessed as “ low but within the normal range”. He prescribed a combination of Romicin and Co-Trimoxazole antibiotics-somewhat less than the usual number prescribed by female general practitioners.
At a consultation with Dr Retford on 15 August 2008. She prescribed antibiotics and a referral to the gastroenterologist of my choice.
Two “ committed” comments were overheard from a local general practitioner namely Dr Van Roekel a few years ago while I was waiting in the practice’s reception area. He provided an effusive written reply/apology as a result of my complaint via The Health and Disabilty Commissioner/Advocacy Service in 2008.
Two replies from Wellington general practitioners namely Doctors Delaney and Dr Waite were unsatisfactory –the former was somewhat incoherent whilst the latter reply contained erroneous biographical detail and recall.
On 22 October 2008 with Retford she again prescribed antibiotics namely cipflox and co trimoxazole also anti inflammatory tablets and lipex. She checked my chest with the stethoscope and advised that she detected some “crackles” in the left lower lobe. Although she didn’t examine the nostrils/sinuses she did take a swab from the right nostril . She also sent a referral to Greenlane Dermatology the probable basal cell carcinoma –nodule- on the right arm. She didn’t know whether the hospital policy had changed –several years ago Greenlane would remove only the more serious lesions –anything less serious, particularly a lesion on the limbs was normally attended to in private practice. She did not take my blood pressure on this occasion.Dr Retford prescribed ciprofloxacin co-trimoxazole and lipex . On 24 December 2008 she prescribed Metronidazole prior to a tooth extraction.
On 15 May 2009 I had as usual been experiencing discomfort in the chest particularly the left lung associated with some morning chest sputum and discharge from the nose. Dr Retford did not check my chest but prescribed a course of amoxicillin and ciprofloxacillin. Her nurse tested my blood pressure and it was somewhat higher than normal at 158/90. Retford also seemed a little concerned about the higher diastole reading.
On 13 August 2009 I attended Dr Gates at the Meadowbank Medical Practice. Prior to the consultation there were “ assassinated and committed” asides from Dr Gates. He was unable to prescribe ciprofloxacillen as he considered he was unable to do so without specialist approval and felt that I should take the matter up with Dr Wilsher. He seemed to have scant regard for the seriousness of the gram negative infections suggesting that even though the bacteria was specified I wasn’t necessarily being affected by it – he also cited the lack of reporting of white cells in this regard He did however renew some prescriptions of carbimazole diclofenac and lipex.
Dr Retford has set up a new practice on Remuera Road in conjunction with 3 other doctors .As I had been experiencing the usual set of flu symptoms Dr Retford prescribed a combination of erythromycin and Romicin on 19 November. A few days later I was afflicted with severe pain in the legs and the appearance of copious amounts of thick green sputum from the chest accompanied by severe coughing fits most often in the wee small hours. The prescribed antibiotics were virtually ineffectual and subsequent to a sputum test undertaken by Labplus on 24 November there was a diagnosis of Haemophilus Influenzae -. Recommended drug treatment is amoxicillin, cefaclor ,cotrimixazole and tetracycline. I also received a referral to radiology for a breast ultrasound. I obtained a script for Augmentin from Dr Dryden at Eastridge medical on 30 November however I subsequently discovered that I had been provided with a generic substitute namely Synermox 625mg which had replaced Augmentin .
Since the onset I have developed severe discomfort in the right lower lumbar area and also the right knee-possibly a type of septic arthritis resulting from the infection. On 8 December the worst of the infection has significantly diminished although there has not been much change in the pain. I visited Dr K Aweidah on 10 December 2009 and received a prescription of Amoxycillin. He undertook a brief check of my chest with the stethoscope and claimed to find nothing of significance. He did not check my blood pressure.
A further consultation with Dr Nicki Retford on 17 December 2009 resulted in a prescription of both synermox and doxine tablets. The blood test performed by Labplus on 19 November indicated a higher than usual neutrophil count of 7.84 ( norm 1.90-7.50) and monocyte count of 1.10 ( norm 0.20-1.00). The lymphocytes remain a constant 1.63 (norm 0.90-4.00) which might be considered borderline low. The ESR ( an inflammatory indicator) was also high at 34 ( norm: 0-30. She did not undertake a blood pressure check nor did she refer to the blood test results. ).
In the absence of Dr Retford I consulted with Dr A Twhigg at One Dental on 19 February 2010. I requested another round of antibiotics as I was still afflicted with a chest infection and inflammation. She seemed to be intent on prescribing a combination of antibiotics namely Romicin and synermox ( a generic substitute for Augmentin) as she felt Romicin would assist with the inflammation. I pointed out that in respect of Haemophilus influenzae with which I was possibly still afflicted a specific drug regime was recommended by Labplus and it did not include Romicin. I had taken a course of erythromycin during the early stages of influenzae and the drug was ineffective. The likelihood of Romicin being any more effective is probably also remote. Medsafe drug sheets advise that Romicin has intermediate sensitivity to Haemophilus but is not the first drug of choice. I was prescribed courses of Synermox and Co-Trimoxazole. A check of my blood pressure showed a reading of 180/?. Dr Twigg suggested that I contact the nurse and continue to have the pressure checked.
On 15 April 2010 Dr Retford prescribed synermox , romicin and simvastatin tabs. My Bp was 160/???. I had emailed her a number of files prior to the consultation however she claimed not to have received them. The files were emailed a second time with a request for her to acknowledge receipt of same however there was no reply.
I consulted Dr Govind at One Health Remuera on 22 May. He prescribed Romicin and Co –Trimoxazole for continuing infection. My blood pressure reading at this time was 160/88 .
On 25 January 2011 a blood pressure check indicated a reading of 150/90?. I advised that my symptoms including the bouts of severe discomfort in the centre of the chest had not changed since last July. Retford did not attempt to stethoscope the chest or check the throat for inflammation and simply prescribed another round of alternative antibiotics namely ceclor and doxycycline.
A consultation with Dr Aweidah on 7 April 2011 resulted in a prescription for amoxycillen clavulate. I advised that doctor that I had been afflicted with a nagging cough for several months –he apparently considered that most cough medications wre a waste of time. Mr Aweidah is invariably a “minimalist” in terms of medical advice.
I saw Dr Retford again on 11 June 2011. She prescribed synermox ,ciprofloxacillen and 2 inhalers –my chest and sinus infections together with the irritating cough have continued for almost 12 months. In respect of gastroenterology Retford had discussed the matter with her colleagues and she did not think that barium investigations would serve much purpose and that perhaps any further scans generally might not be appropriate if not perhaps harmful. A CT scan was not mentioned. I had explained that I had suggested barium scans as an alternative as no film of either the endoscopy or colonoscopy were retained at public hospital in 2003. I had been experiencing a few problems with delays in bowel evacuation. Melanosis coli was diagnosed –attributed to overuse of laxatives. Retford advised that the non-retention of film was standard procedure at public hospital. Nothing untoward was diagnosed in the recent thoracic spinal x ray –I had suggested a whole spine/neck as I have problems in that area as well as the lumbar area. She has requested a follow up pelvic ultrasound. Retford did check my throat which she considered to be inflamed and proceeded with a throat swab.
I spoke to a receptionist at One health on 22 June and she advised that there was nothing untoward in the lab result and that I would have been contacted by the nurses if that was the case. It is now nearly 12 months and the symptoms of quite severe discomfort /inflammation in the centre of the chest and throat accompanied by a persistent night time cough have resulted in no diagnosis despite a sputum test and throat swab. An article contained in Greypowers magazine of June 2011 reported that an increasing number of adults had been afflicted with pertussis ( whooping cough) in the Waikato area over the last ten years. Waikato DHBs programme Manager of Comunications Kathy Jenkin had a severe bout of whooping cough for almost six months in 2009/10. She complained of being “ “unable to breathe in…and would nearly pass out-the worst illness I had ever experienced” The recommended drug regime is either erythromycin or co-trimoxazole.
On 22 September 2011 Dr Retford She gave me the results of recent blood tests performed on 31 August 2011. A probable streptococcus pyogenes infection was diagnosed ( 600 U/mL (<200?H) – 200-680 Equivocal. I wasn’t contacted about this diagnosis and only became aware of it at the consultation of 22 September 2011. Possible complications arising from S Pyogenes include pharyngitis, impetigo,necrotizing fasciitis,rheumatic and scarlet fevers. The CRP ( C-reactive protein) was elevated -5mg/L ( <5) H. CRP is an inflammatory indicator. CRP level is an independent risk factor for atherosclerotic disease. Patients with high CRP concentrations are more likely to develop stroke, myocardial infarction, and severe peripheral vascular disease. Elevated CRP values of Streptococcus pyogenes or Streptococcus pneumoniae in etiology, if left untreated, may also lead to sinus empyema.( abscess) I received a prescription for co-trimoxazole and ciprofloxacin The CRP level was not referred to by Retford neither were a high GGT 54 U/L ( <50)H and a low eGFR . – The ESTIMATED GLOMERULAR FILTRATION 68 mL/min/1.73m2 (>90)L is an indicator of kidney health. In adults, the normal GFR number is 90 or higher. Laboratory tests performed for Cardiologist Dr Webster/Dr Retford on 17 January 2012 were almost identical i.e. eGFR 70Ml raised or high GGT mma-glytamyl transpeptidase is an enzyme which is found in hepatocytes and biliary epithelial cells. GGT may be high in liver disease. In particular it is a feature of biliary outflow obstruction rather than hepatocellular damage.
GGT (in men) = 11 – 50 i.u./l
GGT (in women) = 7 – 32 i.u./l
Note reference ranges may vary between laboratories.
“ GGT serum measurement provides a very sensitive indicator of the presence or absence of hepatobiliary disease. However the usefulness of measurement of serum GGT is limited by its lack of specificity. Raised GGT levels have been reported in a variety of clinical conditions including (1): pancreatic disease, myocardial infarction, chronic obstructive pulmonary disease. renal failure, diabetes, obesity, alcoholism
GGT levels may be elevated in heart failure. Some studies have shown that people with increased GGT levels have an elevated risk of dying from heart disease, but the reason for this association is not known.
Drugs that may cause an elevated GGT level include phenytoin, carbamazepine, and barbiturates such as phenobarbital. Use of many other prescription and non-prescription drugs, including nonsteroidal anti-inflammatory drugs (NSAIDs), lipid-lowering drugs, antibiotics, histamine receptor blockers (used to treat excess stomach acid production), antifungal agents, antidepressants, and hormones such as testosterone, can increase GGT levels. Clofibrate and oral contraceptives can decrease GGT levels.”
On 5 December 2011 I discussed with Dr Retford the recent stenting of the LAD undertaken at ADHB by Dr Webster. I explained that I had been experiencing fairly generalized pain including quite severe pain in the spine legs and feet which was most probably attributable to the continuing infections that I have been afflicted with particularly in the last 12 months with a lingering cough and severe irritation in the throat. I expressed my concern about the attitude of Dr Christmas toward the most recent Streptococcus Pyogones infection and the lack of any reference to this detail in his report. Retford agreed but didn’t discuss the matter further. I had accidentally banged the upper part of my arm in the area near the elbow used in the stenting procedure resulting in some additional bruising and a possible haematoma. Retford provided a stretch bandage and considered that the antibiotics would prevent any infection. She also took a throat swab however she did not request an antibody test as she had done previously. The previous swab had ruled out streptoccus pyogenes. Antibiotics Synermox and Romicin were prescribed .
In consultations with Dr Retford in 2012 I have mentioned the attitude of the two most recent respiratory physicians that I have attended and also queried the additional detail( opacities) on the most recent thoracic x ray.There was little in the way of significant response from Retford .
On 8 June 2012 I emailed Dr Retford with an x ray image of the thoracic spine. Retford authorised the scan in May 2011 . I also queried the houseman unit details pertaining to a nodule in the basis of the right lung and which were specified in the report of the chest CT dated 14 November 2011 from Greenlane.
Retford replied that “ I think that you need to raise these concerns with the respiratory doctors at the hospital, as I have limited experience with reading CT scans and also no access to those done at the hospital. What you are talking about is really in the realm of the specialist. Have you any follow-up booked with the hospital as that is really the place to discuss it? Retford had presumably forgotten?that she had initiated the thoracic x ray and no doubt considered that as a result of the report further specialist consultation was not warranted. .I had nevertheless mentioned my concern about the scan in a consultation with Retford. I find it difficult to believe that her experience with scans is so limited that she doesn’t have an opinion and no doubt she could easily request a copy of the scan as required. She would also presumably be mindful of my dissatisfaction with the attitude of some of the respiratory specialists
On 16 August 2012 I suffered a fall down some concrete steps and banged my head on the adjacent brick wall . There was extensive bruising at the base of the spine and on the right buttock with accompanying swelling and haematoma .
I attended Dr Anna Twhigg at One Health Remuera on 24 August 2012 . There was a cursory check of the buttock and head area with no general examination. If there is no reduction in swelling syringing of the area can sometimes be a consideration however Twhigg didn’t seem to be in favour of this course of action. There were subsequently a few generalised aches and pains including the neck and shoulder coupled with a mild headache and soreness on the right side of the head. Haemorraging from the gluteal artery can very occasionally be a concern . This was mentioned but not further discussed. There is also a smaller haematoma on my head.
She considered that the haematoma on the head would be better left alone and did not consider that a CT scan would be necessarily appropriate at this time based on my lack of significant symptoms since the accident a week earlier. She considered that both the ACC and a specialist might be of the same opinion. She concurred with the skull x ray diagnosis. “ no fracture is seen”
Despite the fact that I was afflicted with severe pain in the lumbo/sacral area in the spine there was no recommendation from the general practitioner as to topical treatment nor a referral for a spinal scan. An ultrasound of the right buttock was performed at Auckland Radiology on 24 August 2012 reported and the haematoma was syringed by orthopaedic surgeon Dr Hucker on 12 September 2012.
Dr Retford on the 2nd of November 2012: Retford had a brief glance at the small bump on the right side of my head but otherwise made no comment and only briefly alluded to the haematoma on the right buttock which had been drained by Dr Hucker . I explained I had also been experiencing some disc pain in left lumbar-I suggested that I might require physiotherapy and she agreed. A lumbar x ray was not discussed.
I referred to the continuing problems in the sinuses i.e blood spotting , occasional severe nose bleeds coupled with stiff necks mild headaches and memory problems. I suggested that empyema/or meningitis might be the reason however Retford doubted that would be the case considering that I would exhibit more serious symptoms if that were the case.
Dr Retford on 8 April 2013: We briefly discussed the result of the metanephrine urine test which generally normal. ( Metanephrine is aka catechcolemine). I am still afflicted with a sinus and chest infection ( last diagnosed by labtests in late January) and I am still experiencing serious discomfort in the legs . She prescribed Cipro and doxycyclin . She did not repeat roxythromycin as she considered that there might be an interaction between the latter and statin medication. She is awaiting the result of another CK test.
Dr Nicki Retford – 4 July 2013: We discusssed the recent blood test which showed an improvement in Hb and RBC’s but an increase in platelets. Retford didn’t consider this to be of any consequence pending another blood test in a week. ( excessive platelets can cause dangerous clotting) The blood test of 4 July 2013 indicates normal results . With regard to the scan of my legs Retford advised she might pursue the matter via Dr Webster –although I might still have the scan done privately. Unfortunately I had transport problems and had to take a taxi from Glen Innes . I was perhaps 10 minutes late for the consultation. A receptionist a large woman with glasses aged 50s was initially very insistent that I could not see Retford as she was very busy etc. She suggested that I see the duty doctor. I said that as I was only 5 -10 minutes late It was surely only a matter of taking another patient ahead of me. After about 10 minutes she had a chat to Retford and we proceeded with the consultation.
Dr Retford -3 september 2013: She advised that she would do a referral to Mr Webster with regard to a possible follow-up angiogram and ultrasound of the legs. She prescribed ciprofloxacillin for the recent diagnosis by Labtests of Pseudomonas and also Trisul. She did not check my blood pressure .
Dr Govind- 22 September 2013- Dr Govind of One Health prescribed Trisul and Cipro ( one weeks supply).
Dr Retford- 18 December 2013. Retford checked my throat chest and carotids –she advised there were no bruits . I recently experienced another episode of sudden collapse precipitated by some discomfort in the forehead area coupled with vision problems namely dark patches in front of the eyes. I recovered after resting for about 15 minutes. Retford suggested a mini stroke was a possiblilty and referred me for a consultation with a neurologist at Auckland Hospital. She did not take my blood pressure . Antibiotics were again prescribed with Curam Duo ( penicillin ) re- introduced. A prescription for cipro was also provided if required. Further sputum tests were requested.” Cardiologist Dr Webster was somewhat vague in his last report concerning my request for a leg ultrasound. Retford suggested that I take the matter up with him at the next onsultation.
On 29 January 2014 I advised Retford that my chest condition had worsened in the last ten days and I was again experiencing quite severe discomfort in the centre of the chest extending around to the spine. She took my blood pressure which was 130/?. She did not check my chest . She re-prescribed roxythromycin only together with codeine and paracetamol for pain relief. She did not consider that additional antibiotics would be necessary until a further sputum test was provided. I emailed Retford images of my chest CT , a carotid report a chest x ray of my mother’s dated 2001, a some earlier spinal reports of mine. She was unable to proffer an opinion concerning either the scans or the reports. This was my final consultation with Dr Retford prior to shifting to Whangarei.
Dr M Gavin of the Medical practice in Onerahi in July 2014: I provided her copies of relevant reports. She did not check my chest although she did provide a prescription for romicin and penicillin –curam duo. A blood pressure check was also omitted Ms Gavin initially suggested that I might be better off attending a more senior doctor and I would agree with her on that. There was a lot to discuss and further referrals will have to be dealt with in subsequent consultations. To date I have received notification from Whangarei hospital concerning a forthcoming chest CT.
Dr Adrienne Henderson at Onerahi Clinic on 21 August 2014: She efficiently proceeded through a number of issues including setting up hospital appointments. With regard to a selection of a neurologist she didn’t think a local neurologist was available and suggested Dr Mark Kennedy. A neurologist is however advertised as being on the staff of Whangarei Hospital. She provided me with a script for Romicin, blood pressure, cholesterol and gastric medication. pending the results of blood and sputum tests. The Blood and thyroid tests have been returned from Northland Pathology on 8 September –still waiting on the sputum test. My blood pressure was 160/?. Henderson did not check my chest or sinuses. She was present when I presented for the blood and sputum tests on 4 September.
During a visit to the laboratory reception at Onerahi medical I briefly visited Dr Henderson to acquire a referral for a continuous sputum tests . She declined advising that I would need to further consult her – suggesting that “ I had been around the ring” and that in fact I was Dr Gavins patient.
I then consulted Dr Roblin of the same practice on …….. He stood behind his desk and computer –the discussion was brief and lasted about 15 minutes when Roblin stated that he had other patients to see.
Dr Russell of white Cross Clinic whangarei ? 2014. My blood pressure was recorded at . 182/118. I showed Russell the result from Northland Pathology –a diagnosis of “Pseudomonas species” and she prescribed both ciprofloxacin and curam duo ( penicillin).
Dr Arkinstall of Primecare Kensington on 16 December 2014: She advised that she felt she was unable to assist me as my case “ was too complicated” Dr Arkinstall is a senior GP. When I suggested that her attitude was discriminatory she consulted with the practice manager to see whether I could see an alternative practitioner in the future. I was then advised that Arkinstall had a full practice and she was not taking on any new patients although this was not specified at the beginning of the consultation nor previously at the reception desk. I asked to look at the x ray of the skull dated 2012 and she concurred with the radiologists assessment of “ no fracture evident” I advised that I was concerned about what was probably a lineal fracture and a possible injury in the area of the crown . A BP test was 134/?. There was a quick aside from the practitioner namely a reference to “ its POP” ( i.e my email outwards)
Arkinstall did provide a referral for a sputum and blood test together with prescriptions for antibiotics and repeats on other drugs. I advised that I had been having monthly thyroid and lipid tests however she considered that the tests only needed to be performed once a year! Dr Arkinstall rang at 5.20 pm to advise that she had received the results of both the blood and lipid tests-the blood test was normal and the cholesterol was 5.3.
Dr Vujcich on 7 January 2015 at the Accident and Medical Clinic on Bank St: He refused to provide any treatment stating that it was inappropriate medically as I didn’t have a temperature (the nurse did record my temperature- only my blood pressure) and that the reason for my being virtual permanently afflicted with pseudomonas aeruginosa was the overuse of antibiotics. I suggested to him that this was spurious reasoning. I have 30-40 year history of lung infections with a variety of pathogens diagnosed since 2003.
I stated that if a diagnosis of a “heavy growth of pseudomonas species” with an accompanying recommendation for antibiotic treatment is made by the laboratory then the general practitioner is surely expected to comply and provide the appropriate treatment. I explained that I frequently experienced severe pain in the centre of the chest, the base of the lungs, the thoracic spine together ith significant inflammation elsewhere including discomfort in the head and neck. – I was also frequently experience a sporadic nagging cough. I explained that I had previously been diagnosed with a lung nodule which has been monitored since 1999 and there now seems to be a disparity concerning the status and treatment of the nodule . I have most recently diagnosed with fibrosis and scarring in the lungs All of these symptoms fell on deaf ears. Vujcich also disregarded the latest CRP ( an inflammatory indicator) result which was recorded as just above the maximum. suggested that meningitis might be an issue however Vujcich considered penicillin inappropriate. Meningitis and even abscesses are often diagnosed in conjunction with Pseudomonas Aeruginosa. I had copies of the laboratory test results for the last 12 months which indicated continuous pseudomonas infections however Vujcich stated that he did not have time to consult the reports.
He insisted that my case was not a matter for a clinic and should be dealt with by a general practice and to that end he made an appointment at the Primecare Clinic with Dr Ryan for later in the afternoon. . I changed the appointment to another date. He also stated that I shouldn’t return to the A & E clinic. I explained that I had previously been to see Dr Arkinstall at Primecare and she had refused to handle my case initially claiming that it was too complex and subsequently that she was no longer taking on any new patients.
The form that is completed by any patient attending any accident and emergency clinic clearly advises the patients that they have the option of having their notes onforwarded to their general practitioner- in other words there is nothing to preclude A & E medical practitioners from substituting for the patient’s own doctors in general practice . Blood pressure was taken by a middle aged blond nurse ( nz/Russian?) 139/75.In addition there was a comment from one of the doctors in the hallway i.e “ that Lou Bone was going to get rid of her!”
I consider Dr Vujcich’s attitude to be nothing more than a callous disregard and unacceptable. By contrast I had a normal consultation with Dr Russell at your clinic a few months ago. I have also attended at clinics in Auckland for many years . The Code of Rights of the Health and Disability Commissioner state:
RIGHT 2
Right to Freedom from Discrimination, Coercion, Harassment, and Exploitation
Every consumer has the right to be free from discrimination, coercion, harassment, and sexual, financial or other exploitation.
RIGHT 3
Right to Dignity and Independence
Every consumer has the right to have services provided in a manner that respects the dignity and independence of the individual.
RIGHT 4
Right to Services of an Appropriate Standard
1) Every consumer has the right to have services provided with reasonable care and skill.
2) Every consumer has the right to have services provided that comply with legal, professional, ethical, and other relevant standards.
3) Every consumer has the right to have services provided in a manner consistent with his or her needs.
4) Every consumer has the right to have services provided in a manner that minimises the potential harm to, and optimises the quality of life of, that consumer.
5) Every consumer has the right to co-operation among providers to ensure quality and continuity of services.
I lodged a complaint about Dr Vujcich’s attitude with the Medical Director of the Clinic Dr Prinsloo. Extracts from his reply dated 13 January 2015 are as follows: “It is not in our field of practice to treat longstanding problems and it certainly is not the best place to attend for these chronic conditions. Even though the GP gets a copy of the consultation notes it impedes the continuation of care and is not good clinical practice or best for the patient..I agree with Dr Vujcich that there did not seem to be enough evidence at the time of your presesntation to suggest an acute incident or any clinical evidence of an acute lung infection. Unless the culture of “ heavy growth of pseudomonas” is a new one ( within the last few days) and there is clinical evidence of an acute lung infection it is definitely contraindicated to prescribe antibiotics . Dr Vujcich did not refuse you treatment but certainly went out of his way to provide you with the best possible care by making sure you had an appointment at your GP practice within a few house on t he same day you presented here for assessment and treatment”
Dr Sophie Hicks at the practice in the Paramount Plaza Tipunga on 20 January 2015: She provided a general neurological check as I had advised that I was concerned about the areas of discomfort including areas of the skull and accompanying short term memory loss. A lack of response in the left knee ( recently diagnosed with osteo arthritis) was evident during the reflex test. Hicks made no comment other than to suggest that although I might have a consultation with a neurologist I wouldn’t necessarily be provided with a scan . She checked my lungs with a stethescope but made no comment. She agreed to prescribe a prescription for 2 weeks of ciprofloxacillin but was not prepared to provide an additional prescription for augmentin. I advised that meningitis was a concern as I exhibited repeated episodes of stiff necks, sleepiness and extensive inflammation and Dr Retford had no qualms about prescribing same.
I pointed out that a recent CRP test an inflammatory indicator was just in excess of the maximum however she seemed to downplay the significance of the test. In respect of my respiratory concerns I advised that I had not been provided with a follow-up consultation at the chest clinic subsequent to a recent chest .I discussed the CT diagnoses of the past few years and my concern about the disparity between the recent recommendation of the radiologist and that of the two senior respiratory physicians in respect of a lung nodule. Hicks demurred and seemed to try to rationalise the disparity. I emailed her film from the thoracic x ray of december 2013 . I had been concerned about one frame namely the T lateral breathing and requested that she onforward the frame/frames to the respiratory clinic and she agreed to this request. .Hicks also agreed to request referrals to both the respiratory and neurology clinics.
I subsequently received a letter from Hicks dated 20 January “ at our appointment you requested a referral to a neurologist to discuss scalp tenderness and memory problems. I can see that you have had a number of opinions and tests regarding these symptoms and I am unsure there is anything more to be gained from a further opinion. I can reasssure you that I do not feel there is a neurological cause to your symptoms”
In fact I received two recent neurological opinions namely those of neurologist Dr Willoughby of Auckland and Dr Kennedy of Whangari a general physician. Kennedy referred to Willoughby’s comments namely that “ he felt the symptoms in late 2013 were likely syncopal in nature with no typical features of posterior circulation TIA or evidence of anterior circulatory disease and did not believe neuroimaging or carotid Doppler would be helpful”
In his report dated January 2014 Willoughby advised: “The recent episode of symptoms were of uncertain cause but sound most like a pre-syncopal episode. There were no typical features of a posterior circulation TIA although it is difficult to exclude that – we can reasonably exclude a carotid territory TIA and I do not think there is an indication to repeat a carotid ultrasound although Ms Wilson has wondered about that. A carotid ultrasound in 2003 showed minor plaque in both common carotids with no stenosis. I do not think repeat brain imaging is indicated but we should re-consider that if her course is unsatisfactory.
Dr Hicks’s assessment would seem to be at odds with that of Willoughby”s
In her email dated 28 January 2015 Hicks advised “I apologise that I did not confirm the referral I made to the respiratory clinic in my letter and that I did not acknowledge your email last week. This was indeed completed on the 20th January and has been accepted by Whangarei Hospital, you should receive an appointment in the post. I am struggling to attach all the images that you requested though. The referrals are electronic and have a limit on data quantity that can be sent. I have attached what I am able and the most relevant that I felt”.
A spokesperson at the respiratory outpatients clinic at Northland DHB initally advised that the referral hadn’t been received then after a further search advised that only the referral had been received but not the images.
On 2 February 2015 Hicks further advised: “I am not sure why that is. It has definitely been received as the practice receives confirmation from the physicians. I suspect it is to do with processing through to appointments and we need to wait a little longer”.
In the event I emailed one image of the T lateral breathing to the clinic.
I visited Dr Kim Rapson of Paramount Medical on 25 February 2015. We discussed cardio neurology and respiratory matters. She was reluctant to refer me to cardiology outpatients until I provided a copy of the latest report from Dr Webster dated February 2014 in which he referred to a follow –up consultation. I emailed her a copy of the report.
I expressed my concern concerning the notation concerning a “ septal infarct” ( heart attack)reported in the ECG of June 2013 subsequent to a gastric hemorrhage. This detail was not referred to in the Cardiologist Webster’s reports. Rapson’s could only comment was “ what would you expect them to do about it?” . !” She did however provide a referral to cardiology.
In respect of my neurological concerns she was not prepared to make a referral to the clinic. There is no resident neurologist at Whangarei Hospital . Rapson was in possession of the latest CT chest scan report from October 2014. I expressed my concern about the disparities concerning the nodule in the right lower lobe-she merely nodded and made no other comment. She provided a prescription Ciprofloxacin but was not prepared to provide an additional prescription for Augmentin. Her concluding comment after about 20 minutes was “ I think you are just about done here
I visited Dr L Harvey who occasionally assists at Paramount Medical in Tipunga. Initially Harvey advised that they were not liberty to prescribe Ciprofloxacin as it had to be initiated by a microbiologist. I stated that would obviously be the case. She then referred to the recommendation from Physician Dr Kennedy that the prescribing of Cipro should cease and a similar earlier recommendation in 2009 from Dr Wilsher. (which was actually ignored by the general practitioners).
Harvey advised that she would first have to examine me . She doubted that there would be enough time remaining in the consultation to discuss other issues. I considered this scenario to be unsatisfactory and aborted the consultation.
Dr Halaghi- Mccarthy of Whangarei city on 4 August 2015: The receptionist provided me with a form to complete as a casual patient but at the same time advising that if I enrolled as a patient it would obviously be cheaper than the $80.00 casual charge . McCarthy checked my lungs with her stethescope and claimed she could find nothing significantly amiss. My blood pressure was 120/80 and my oxygen saturation level normal. I explained that I was experiencing pain in the lungs, the neck ( glands) sinuses and head. Despite these symptoms Dr Mccarthy adopted much the same stance as Dr Harvey advising that she was unable to provide antibiotics without a further sputum test and further advice from specialist Dr Kennedy. I explained that I was dissatisfied with Kennedy particularly his disregard for the recommendation of his radiologist in respect of ending CT lung scans. I showed her the previous sputum tests the most recent being in March of this year and empty packets of previous ciprofloxacin prescriptions including those provided by Whangarei doctors.
She also alluded to Kennedys report which suggested that the sputum samples might have been merely “a mouth contaminant”. Although Kennedys report if 13 March 2013 stated “Ciprofloxacin 500 mg about to cease” he did not necessarily preclude further prescriptions with his subsequent statement “ I have not recommended a further course of antibiotics at this time” McCarthy was not prepared to provide any alternative antibiotic treatment but provided repeat prescriptions of various other medications and advised that I should re-visit my previous GP as she was no longer taking on new patients. I mentioned this to the receptionist after the consultation-she advised that she thought I was an enrolled patient which was obviously untrue as she was well aware that I was a casual patient. Another example of discrimination.
I had twice attempted to contact Dr Retford of One Health Remuera in July 2015 with regard to re-joining the practice. I received no reply from her however I did receive a reply from senior nursing staff Jean Richards on 21 July 2015: “Dr Retford is aware of your request, but her patient register is closed. Nikki is accepting no new patients and this includes re-enrolment of previous patients, as she is over-registered for the number of appointments she has available. Therefore, as patients transfer out, they are not being replaced.
Dr Retford is unable to be seen on a casual basis, as the General Practice service is only available to enrolled patients. However, as Sharon advised, you are welcome to enrol with Dr Letica who is accepting new patients.” I recall a derogatory comment from Letica in reception. I had been a patient of Retford’s for approximately 10 years.
I have attended Dr Nikki Retford for several years and while she has been generally overtly helpful she seems to be reliant on the opinion of specialist and radiologists and reluctant to proffer an opinion on radiological scans. She is now a practitioner in a Beachlands.
As I had experienced difficulty obtaining a referral to a neurologist ( there is no resident neurologist in whangarei) I received a referral from Dr Catalina Wong of Auckland to neurologist Dr David McCauley who requested a brain MRI. As I received no further advice from McCauley subsequent to the scan and due to the fact that I also had queries concerning two areas of non-diagnosis I contacted Dr Wong detailing my concern however in her email dated 21 December 2015 she advised “ you are a casual patient.. living in Whangarei……you will be better served if you enrolled in a practice closer to you. I therefore urge to take your MRI report together with your history to a local clinic of your choice to help you”
A consultation with Dr Bornholdt on 9 December 2015: I explained that I had a combination of problems including symptoms detailed in the recent MRI brain scan in combination with ongoing Pseudomonas Aeruginosa sinus and chest infections and also a probable cases of maelena precipitated by an anti-inflammatory tablet. I had copies of two images from the brain MRI however Bornholdt claimed he was unable to interpret scans and doubted that I would be likely to either. He checked my chest with the stethoscope and could find no evidence of anything amiss and a similar assessment after a manipulation of the sinuses. I had explained that I get pains in the chest and suffer from inflammatory discomfort in the head and have a long history of gram negative infections. He reluctantly prescribed a minimal dosage of Ciprofloxacin namely 500 mg per day for a week ( normal prescription 1000 mgs per day for 2 weeks.) supplemented by a weeks supply of augmentin. As he considered we were of differing opinions he advised against registering with him. As of 3 January I have a severe croup like cough particularly in the morning.
Dr Henderson at Onerahi Medical centre on 11 March 2016.: I attended as a casual patient. She provided referrals to both a respiratory and neurologist in private practice. I showed her 2 images copied from the recent MRI brain scan, one indicating leptomeningeal enhancement and the other probable thrombus/thrombi? In the superior sagittal sinus. I expressed my concern that neither of these 2 conditions had been diagnosed at Mercy radiology however Henderson seemed to disregard this aspect as somewhat insignificant . While she prescribed a 10 day prescription for ciprofloxacin she would not prescribe any penicillin . She considered that the Cipro would be sufficient treatment for the meningitis as I wasn’t afflicted with the full range of symptoms. Medscape “:Ceftazidime or cefepime are the recommended antibiotics for treatment of meningitis arising from a pseudomonas aeruginosa infection. Ciprofloxacin is an alternative treatment.”
Dr Henderson September 2016: She checked my blood pressure at my request which was recorded at 135/80. She agreed to onforward requests for consultations at endocrinology CT radiology, mammography. She also provided a form for a blood test a referral to the laboratory for a stool specimen ( no abnormality was subsequently indicated in the laboratory report) In respect of my neurology concerns she seemed doubtful that she could make any further progess in this regard suggesting that alternative neurologists might be of the same mind as McCauley and Charlesworth.!
On 15 August 2016 I received emailed advice from Practice Manager Ian Watkins of the West end practice in Maunu Whangarei : “ I am sorry I cannot meet your request as our books are currently closed and we are not taking on new patients”.
4 April 2017: I was once again afflicted with a chest and sinus infection and was duly prescribed ciprofloxacin together with repeats for my regular medications by Dr Henderson.. A stethoscope investigation of the chest revealed some “ crackles” in the left lung. As I had complained of occasional small sharp pains in the stomach and occasionally in the right groin augmentin was also prescribed.
Wikepedia advises “ Crackles are often associated with inflammation or infection of the small bronchi, bronchioles, and alveoli. Crackles that do not clear after a cough may indicate pulmonary edema or fluid in the alveoli due to heart failure, pulmonary fibrosis, or acute respiratory distress syndrome.”
On 22 June 2017 I emailed Dr Henderson a copy of a recent mammogram which also depicted an area of the chest which when magnified showed an area of dense opacities. In her reply Henderson advised :
Hi Vicki
Thank you for the films. I am not a radiologist but from my training I cannot see any features on your imaging that would raise alarm bells for me. The patchy changes in your screen shot are normal findings on many x-rays – particularly when looking through dense tissue due to the variable uptake of the x-ray radiation. Dr Kim Shepherd is a very skilled radiologist who reads the vast majority of breast imaging and I have faith that she would have reported any changes of concern. Regards Dr Henderson
Ciprofloxacin continued to be prescribed in August and 25 September 2017. Prior to the consultation on 25 September an unfortunate comment was overheard from Dr Henderson namely “ committed nut case”. She has since left the practice.
In December 2017 Dr Sophie Cruse at onerahi medical: my request for a prescription of ciprofloxacin was declined by Dr Sophie Cruse as while a “ heavy growth of gram negative bacilli” had been reported a culture had not been specified in the laboratory test.
Although I pointed out to both doctors that laboratory microscopy details which specify “ large numbers of gram negative bacilli” are the equivalent of a diagnosis of pseudomonas aeruginosa which I have been almost exclusively afflicted with for almost 20 years and almost exclusively for the past the last few years. However the logic of this argument fell on deaf ears.
Consultation with Dr Deijten of Onerahi Health on 6 January 2018. She checked my heart and lung function but made no comment. She also checked my throat which she advised was a little inflamed on one side and took a swab for the laboratory. I advised that I regularly experience severe discomfort in the centre of the chest and lower lobes of the lungs in conjunction with occasional pains in the head and sinuses and memory problems. Dr Deijten did not consider that a prescription for cipro was appropriate as the two most recent sputum tests specified “ large numbers of gram negative bacilli” but not a pseudomonas aeruginosa culture. She provided a form for a chest x ray at public hospital. In respect of my head injury on 20 December 2018 Detjen conducted some visual tests and lightly touched my head. She completed an ACC form but did not but failed to hand it to me . I visited ED at Whangarei Hospital on 8 January 2017 where the reception staff subsequently obtained the ACC number from the practice.
A reply received from Dr Tan in February 2018 a respiratory physician at Whangarei Hospital recommending a cessation of antibiotics was in response to an apparent identical request from a medical practitioner assumed to be Dr Detjen of the Onerahi medical centre. In addition the practitioner had requested a “block” at Labtests concerning any future lung sputum tests. This would appear to be seriously obstructive tactic as the practitioner could easily have checked sputum tests over the last 15 years which clearly indicate a chronic long term sufferer Recent CT lung scans indicate scarring, fibrosis and a possible malignant lung nodule. ( see also RESPIRATORY) Any coughing is related to my chronic long term chest infections and not ACE induced.
A prescription was eventually provided by Dr Barnes at Onerahi Medical on 21 February 2018 subsequent to a culture diagnosis of “ heavy growth of pseudomonas aeruginosa” on 19 February 2018. Although photographs of the sputum tests of 19 February and 7 March 2018 were virtually identical pseudomonas was only specified in February with -“ small numbers of gram negative bacilli” reported in March.
The diagnosis of a “heavy growth of gram negative bacilli” is the equivalent of a culture “heavy growth of pseudomonas aeruginosa” . Although the miscroscopy details are the same the culture is not always specified. As a result I had been without appropriate antibiotic treatment from September 2017 until February 2018. The medical practitioners seem to be unnecessarily obtuse in this regard. I queried this disparity with Labtests however I was advised that the query should be initiated by my medical practitioner. On 12 June Dr Sprague seemed a little reluctant to pursue the matter .
23 March 2018: Subsequent to checking my chest with his stethoscope Dr Barton of Onerahi medical claimed evidence of any infection wasn’t readily apparent although I had been producing significant somewhat viscous sputum for the last month. A photographic enlargement of sputum specimen clearly illustrated large bubbles however Barton made no comment. He did not consider a further referral to the heart clinic was necessary but was amenable to an ECG performed at the practice. Neither did he consider that a referral to gastroenterology was necessary at this stage. Dr Barton did provide a prescription for ciprofloxacillin and Romicin and a form for further sputum tests at pathology.
During a visit to reception at the Onerahi practice Dr Roblin appeared, uttered a “ nutter” comment, laughed, and returned to his office.
Although Dr Bloedon of Onerahi medical had provided a prescription of Ciprofloxacillin on 7 July 2018 he was reluctant to repeat the prescription on 31 July . He seemed to have misinterpreted the advice of Respiratory Physician Dr Bradley who although she had sounded a note of caution in respect of antibiotic treatment she did not preclude treatment when there was “ a marked increase in sputum with colour change plus or minus fever and true infection is indicated. (I have provided photographic evidence of the yellowish sputum over the years.) She added the proviso “ I would stop culturing unless she was clearly not responding ”
On 9 August 2018 Dr Sprague provided a prescription for Doxycycline and Ciprofloxacin . I provided him with photographic evidence of two areas of concern namely the dense opacities evident in a mammography frame and the probable skull fracture. Dr Sprague was not prepared to provide an opinion and suggested that I should consult a lawyer who specialises in medico-legal matters. He didn’t provide a referral to the gastroenterology clinic or a possible endoscopy procedure.
On 10 October English general practitioner Dr Prenton provided a prescription for Ciprofloxacillin and doxycycline. She also provided a referral for a thyroid lab test. I had requested an extended consultation time which was taken up with my advice concerning my medical concerns. Prenton advised that in the interim she would prefer to investigate my medical history and suggested that I make a subsequent appointment. I had previously emailed medical images to administration at Onerahi Medical which I was advised were retained in a folder however it isn’t clear as to whether either practitioner have seen them.
I attended Dr Grace Couper at Bush medical Kamo on 8 January 2019. She provided me with a script for my regular medications as well as Ciprofloxacillin for Pseudomonas infection. I had sent her an email complete with images which detailed my concerns however these were not discussed . Dr Couper is now on maternity leave.
Chest sputum tests of December 2018 and February 2019 indicated a recurrence of “Pseudomonas Aeruginosa and predominantly gram negative bacillus Unfortunately on 6 March 2019 Bush Road practitioner Dr Hedlund did not see fit to prescribe antibiotics but rather considered that the only medical requirement was a nasal spray. I had also emailed copies of medical images together with my queries to Bush Road Administration. Dr Hedlund appeared to have the images in a file. As I abbreviated the consultation these matters were not discussed.
On 16 April 2019 Dr Zender of Bush Road Medical provided a script for my usual medications as well as Ciprofloxacillin and Romicin. I had sent Dr Zender an email on the previous day advising that she could retrieve the file of images from Dr Hedlund however she claimed that she hadn’t receive the email so I provided her with a copy of it. Gastroenterology matters were discussed and Dr Zender indicated she might progess further investigations. She suggested that I return for another ½ hour appointment to discuss respiratory, neurology , haematology and other matters.
At a subsequent consultation with Dr Zender on 4 June 2019 she provided me with a script for ciprofloxacillin and doxycycline for treatment of the endlessly recurring pseudomonas aeruginosa. Approximately 10 minutes of the 15 minute consultation was taken up with a protracted explanation as to why she hadn’t progressed a request for further investigations at the gastroenterology clinic. On this occasion Zender seemed to agree to progress a request for an endoscopy and ultrasound however she considered there were limited resources at the hospital clinics and a repeat endoscopy and colonoscopy might not be likely.
The previous endoscopy/colonoscopy was performed at ADHB in 2003. Melanosis Coli was diagnosed. I had requested that a panel dated August 2018 be repeated at the laboratory at Whangarei Hospital . High immature granulocytes, High fibrinogen Assay, High anion gap and abnormal leucocytes were diagnosed . However Dr Zender only provided a referral to Northland pathology for lipid and ACR urine tests. The test for lipids had been omitted from a recent blood test. She examined my stomach, and my chest with a stethoscope and also took my blood pressure but otherwise made no comment! I have since received notification that a gastroscopy procedure has been scheduled. The previously emailed abbreviated complaint which also contained medical images had still not been retrieved for discussion at the consultation.
Heavy growth of Pseudomonas species was reported by Labtests Auckland on 29 July 2019. In August 2019 I requested a script from Dr Zender for Ciprofloxacillin and Trisul. A text reply from a member of the nursing staff advised that Dr Zender was only prepared to provide a script for a limited number of Trisul tablets. I decided to seek an alternative opinion and visited Dr Limby of the same practice on 8 August 2019. Limbys attitude to prescribing Cipro was identical to that of Dr Zender.
She claimed that there was a restriction and prescribing Cipro was bad practice. A script for 2 weeks supply of Trisul was provided. (Although Trisul is prescribed for some gram negative infections pseudomonas is considered to be somewhat resistant to this drug). Dr Limby also queried the need for sputum tests. The last specialist seen in April 2016 was Dr Cornere of Waitemata DHB . She prescribed Ciprofloxacillin and suggested “If pseudomonas remains a concern we could consider 3 months treatment with nebulised aminoglycosides as she has had multiple courses of ciprofloxacin in the past”.
I requested a referral to Norpaths hospital laboratory. In respect of a high immature granulocytes reading provided by Norpath in 2018 Limby was rather dismissive of the test seemed to ignore the fact that granulocytes are an important sub-group involving the bone marrow. She alluded to a recent normal neutrophil count as indicative and sufficient. Norpath advises “Causes of a raised Immature Granulocyte Count include sepsis, inflammation, haematological or other malignancies, and conditions where there is a leucoerythroblastic picture.” I undertook a colonoscopy at ADHB in 2004 and Melanosis Coli was diagnosed . I requested a referral to NDHB for a sigmoidoscopy however Dr Limby advised that she could only refer me for the procedure as a private patient. I had brought copies of the medical images about which I was concerned however once again they were not discussed. Limby did not consider that a further attempt to resurrect specialist consulations and scans at NDHB was her responsibility.
On 2 September 2019 Bush Road practitioner Dr Miller provided prescriptions for two weeks each of Ciprofloxacin and Doxycycline as treatment for Pseudomonas Aeruginosa and a blood test at Labtests. He also provided a referral for a CT colonography which is scheduled for October. I provided him with copies of medical images about which I was concerned however there was no response from Miller. I subsequently onforwarded the images to Dr Miller via email. He did not check either my blood pressure or my chest.
On 25 September I endeavoured to obtain a further prescription for Cipro and was advised by the nurse/receptionist that a script would be available the following day. On 26 September I received a text from Staff member Ronda to advise that Dr Miller would not be prescribing a script and she enquired as to my symptoms and in particular whether I had temperature. I advised that was not usually the case but that I was afflicted with the usual symptoms in the chest and sinuses. It does seem rather unusual that a doctor would request a staff member to diagnose over the phone. Ronda also advised that Dr Miller would not be available to see me again as he already had too many patients and that the previously scheduled appointment on 9 October 2019 would be cancelled. This was confirmed by Dr Miller by way of an email “Hi Vicki. I’m only working part _me and was job sharing with another doctor who has just left so I’m swamped with my own registered patients and hers. My admin staff have been asked to make appointments with me for only my patients. That is the reason Rhonda advised you I wasn’t available.” I had seen Dr Miller previously on 2 September however I was not provided with that advice on that occasion.
On 30 September I received a statement of account requesting payment of $20.00 to Dr Noda for a prescription. I telephoned the practice and was advised by another staff member that there was a prescription for 2 week of ciprofloxacillin provided by Dr Noda which had been onforwarded to Orrs chemist. A subsequent check with Orrs revealed that there was no trace of a prescription. During a follow up phone/con with Ronda she became rather belligerent insisting that I had been told “that I was not clinically unwell and thus no prescription” and it was her opinion” that ciprofloxacillin was not an appropriate medication for pseudomonas.”.
She couldn’t seem to explain the account from Dr Noda. I emailed a query to Dr Noda on 2 October 2019 but received no reply. An email was received from Sandra Hawkins the practice manager who advised “you can leave your account balance in credit by $20 which will pay towards any visits or prescription charges in the future.Dr Noda asked me to reply to your email as she had not completed a prescription for you and has not seen you previously.” !! I agreed that the account could be left in credit.
During a consultation with Dr Noda on 24 October 2019 she advised that she had not previously prescribed ciprofloxacillin which didnt explain the $20.00 prescription attributed to her. She provided me with scripts for my usual medications and eventually after much persuading and reluctance an additional prescription for ciprofloxacillin. I provided Dr Noda with evidence of 16 years of primarily gram negative chest infections She was not prepared to make any comment about the image from a mammogram depicting dense opacities apparently involving the chest wall. Dr Noda then erroneously advised Northland Pathology “ sputums are no longer required for this patient .
A subsequent consultation with Dr Geoff Cunningham of Bush Road medical on 17 December 2019 resulted in a protracted discussion with Cunningham about the lack of reporting of a sputum culture despite the microscopy details in tests being identical in some of the tests. Dr Cunningham would not accept that there was a disparity and was not prepared to prescribe medication even though “predominantly gram negative bacilli” had been indicated in the test dated 7 December 2019. The identical details were reported in July 2019 with a specified culture of “ heavy growth of pseudomonas aeruginosa” . I presented my list of chest infections diagnosed since 2003 however this evoked no response.
In addition I had advised that I had been experiencing head and chest pain and a very sore throat. Dr Cunningham took a swabs from both the throat and tongue but otherwise made no comment. He also requested another sputum test which has now been undertaken as I subsequently developed a severe chest and sinus infection. I managed to reduce the severity of the symptoms with natural emedies.
I showed Dr Cunningham an image indicating dense opacities apparently involving the chest /breast areas however he dismissed that as “ that’s nothing”. He was likewise dismissive concerning Dr Corneres’ suggestion of a 3 month trial of aminoglycocides as treatment for chronic long term sufferers. Dr Cornere is the clinical Director of Waitemata Respiratory medicine.
I consulted with Dr Audrey Thorpe at North Harbour Medical on July 2020. There were assorted comments from both Dr Audrey and her male counterparts/incarceration( “why committing/JB and CD .) Dr Thorpe was helpful and provided a referral to the breast clinic. Referrals to the Cardiology, Neurology, ENT ,Dermatology and Orthopaedic clinics have yet to be arranged. She also provided a prescription for all my medications
At our consultation on 24 November 2020 Dr Thorpe and I further discussed the unsatisfactory aspects of the breast ultrasound performed in July 2020. Dr Thorpe seemed reluctant to progress the enquiry beyond once again requesting another review of the scan. She also did not consider it necessary for her to obtain a copy of the breast ultrasound dvd. She agreed to request a further consultation at the neurology clinic. The antibiotic Levofloxacillin was discussed as an alternative to ciprofloxacillin and Thorpe advised that she would need to seek advice from a microbiologist. ILevofloxacillin was available but at considerable cost as the drug was not on the approved list. In the interim she provided a prescription for co-trimoxazole to treat a recent diagnosis of serratia liquefaciens. A blood test has also been requested
in June 2022 the vascular clinic at ADHB advised that a referral had not been received from my GP.
On 14 November Dr Thorpe requested another blood test to include CK and fibrinogen and a prescription for respigen inhalers and ciprofloxacillin. My BP was 130/74 A rudimentary spirometry test was not available at the practice.Both Dr Thorpe and I requested another opinion concerning the recent skin excisions performed at skincheck -in particular an excision on the left thigh which had been diagnosed at the anatomical laboratory as an inflamed regressing wart. 2 months later it was re-diagnosed as a keratoracanthoma.
During a further visit to Dr Thorpe on 6 January 2023 At my request she provided a blood pressure reading of 150/80 and a further prescription of ciprofloxacillin for the resistant but undiagnosed chest infection. I also requested a referral back to dermatology for a complete body check.
There was a subsequent phone consultation with Dr Thorpe on 31 January 2023. She agreed to provide a prescription for further antibiotics- I had requested a slightly higher dosage however the chemist queried this and the prescription was cancelled. Dr Thorpe was not prepared to further prescribe my regular dose at this time pending a possible discussion with a respiratory physician. It seems to be unnecessarily pedantic as I have been medicated for chest and sinus infections for over 30 years. I requested a referral to radiology for a pelvic ultrasound I once again asked for a referral to the vascular clinic for a carotid ultrasound and this was agreed to. “Mild to moderate carotid lesions were diagnosed in 2003 but none so severe that required revascularisation” The vascular clinic at ADHB had previously advised that they had no record of a referral . Dr Thorpe advised that Waitemata dermatology don’t provide full body checks so I will need to continue to have checks privately. A further CBC will be requested.. We discussed the possibility of a prescription of ticagrelor as an option to clopidogrel. Caution is required in the use of both drugs but more particularly in respect of clopidogrel particularly if there is a history of stomach ulcers.. I was afflicted with a haemorrhage in 2013 from a duodenal ulcer.
On 3 February 2023 I attended Dr Walid Waked at the Shore Emergency Clinic at Takapuna. He checked my chest and provided me with a good supply of amoxicillin and doxycillin. 2 blood pressure readings were taken the first was 160/77 and the second 158/76. The blood pressure readings were not discussed. :
Obs noted looks well full sentences Well perfused no rash ENT – NAD No LN+ CVS dual nil added Chest bibasal crackles No wheeze ( I do have fibrosis in the lungs)

Medical News Today advises: Bibasilar crackles are abnormal sounds from the base of the lungs. They indicate that something is interfering with airflow. Two issues often cause bibasilar crackles. One is the accumulation of mucus or fluid in the lungs. Another is a failure of parts of the lungs to inflate properly.The crackles themselves are not a disease, but they can be a sign of an illness or infection. Many conditions can cause bibasilar crackles, and they are usually based in the heart or lungs. They include pneumonia heart failure pulmonary edema and bronchitis.

EDACS = 10 (Excessive dynamic airway collapse)
Declined ECG
PO abx – pt requesting 3/52 course.
I encouraged coughing and clearing chest as best as possible Recomended f/u with GP if sx persist / worsen
3 weeks – Amoxicillin 500Mg Cap///3 weeks – Doxycycline 100mg Tab
Dx:Acute lower respiratory tract infection (H062.00
Consultation Waked – 17:30 As per triage : Presents with productive cough with CP due to coughing. Also has sinus pressure sx. She has had multiple chest infections due to underlying Bronchiectasis and has multiple documented sputum samples on Testsafe. She is requesting a course of abx which usually helps clear her sx. She has been on various abx in the past and finds that an extended course helps clear and prevent the infection. She reports her CP has been present for more than 1/12 and believes it is related to her persistent coughing. No assoc SOB or fever. No palpitations, sweats, dizziness or orthopnoea. Mild bronchiectasis .
Pmhx: 1. Ischaemic heart disease. Angiogram 2015: Patent stent left main into proximal and mid LAD. Occluded LAD stent after second diagonal – well collateralised. Ostial occlusion LCx-well collateralised. Mid RCA occlusion.
Triage: BP 160/77 mmhg////(at 5.03 pm)//bilateral BP right 150/76 //left 145/75 (at 5.39 pm). A reading earlier in the day at the local chemist produced a reading of 138/79.
A further consultation at Shorecare on 2 March resulted in a brief consultation with a female doctor named Heather (surname not specified). She claimed to be aware of my concerns but was however reluctant to prescribe a further prescription of ciprofloxacilin without a consultation with a respiratory specialist. I ddnt consider that action was necessary and concluded the consultation. I was offered a second opinion with another GP however after a wait of 1 ½ hours I departed.

Correspondence between Dr Thorpe and myself in February 2023 is self-explanatory.

23rd February 2023
Dear Vicki,
have reflected on our recent conversations, particularly regarding the ciprofloxacin prescription that you requested.
I understand that you were unhappy that the pharmacist phoned me to question the prescription. This is part of their professional responsibility to ensure prescriptions are as intended.
After that call, I considered it sensible for me to seek expert advice. It is important that antibiotics are only prescribed when indicated as inappropriate prescribing can lead to community resistance to antibiotics, Therefore, I discussed your sputum sample result with the specialist microbiologist at Labtests and then following their commentary I decided to cancel the prescription.
You and I had a further conversation on 1st February where I explained the advice had received and why I thought the ciprofloxacin was not indicated.
My impression is that you do not accept the results from Labtests, their ability to do a reliable test, or the advice I received from the microbiologist.
Subsequently on the 2nd February I consulted with a respiratory physician at North Shore Hospital who you have consulted previously. They confirmed that should treat you on clinical grounds, not sputum cultures- I that basis, I remained of the opinion that the ciprofloxacin is not indicated.

I conveyed this to you in an email.

I feel you are unwilling to accept my intention and effort to make a safe and appropriate decision regarding this medication, based on the best advice can find, including two relevant specialists.
My impression is that you do not trust my judgement and my efforts to seek expert guidance to guide my advice to you.
Trust in fundamental in the doctor patient relationship-
Dr Groen and Dr Gentry are available to see you if you wish. I wish you all the best for your health in the future.
Yours sincerely Dr Audrey Thorpe. North Harbour Medical Centre
Dr A Thorpe
North Harbour Medical
Hello Audrey,
Your email dated 23 February 2023 refers.
As I recall I had requested an increase of my ciprofloxacillin from 1500 to 2000 mgs per day, The chemist at Countdown decided that the dosage was inappropriate and advised you accordingly. Instead of requesting the prescription be changed to the previous dosage of 1500 mg per day you cancelled the prescription. I have had a serious cough with copious amounts of sputum for months . I thought that action was inappropriate . Gram negative bacillus ( unspecified) have been recently diagnosed since October 2022. A test dated 9 January 2023 specified “mixed organisms predominantly gram negative bacillus” It might indicate that more than one pathogen is involved which could possibly require different medication. A recent sputum test dated 17 February 2023 diagnosed heavy growth of pseudomonas aeruginosa. This is the only specific diagnosis for 2 years. Cessation of diagnosis after 18 years since 2003 might call into question the credibility of Labtests staff.
You advised that “a respiratory physician confirmed that I should treat you on clinical grounds not sputum cultures” I would have thought that In respect of patients with chronic conditions a sputum specimen would be helpful if not a requirement prior to appropriate clinical treatment . You have been providing prescriptions of ciprofloxacillin for the last few years -it seems rather odd that you are now suddenly ” of the opinion that ciprofloxacillin is not indicated”

Certain young female relations from the Kassler family advised me a few years ago that “they didnt like my having procedures or assistance” In that regard they began meeting Dr Potter a senior Labtests staff member who had been diagnosing my sputum test for 18 years This might suggest obstructive interference. You may also have had contact with Mrs Ann Simich and Haumaru tenants particularly Mrs Robyn Houston and Mr Graeme Reid and his wife.

I have included a copy of the bacterial infections with which I have been afflicted over the years.
Vicki Wilson
Consultation with Dr Waked on 2 March 2023.
As per triage. Presents with productive cough with CP due to underlying bronchiectasis and has multiple documented sputum samples on Testsafe. She is requesting a course of abx which usually helps clear her sx. She has been on various abx in the past and finds that an extended course helps clear and prevent the infection. She reports her CP has been present for more than 1/12 and believes it is related to her persistent coughing. No assoc SOB or fever. No palpitations sweats dizziness or orthopnoea. Looks well -full sentences well perfused no rash ENT-NAD No LN+CVS dual nil added Chest bibasal crackles no wheeze. Declined ECG Po abx pt requesting 3/52 course I encouraged coughing and clearing chest as best as possible recommended f/u with GP if sx persist /worsen rx 3 weeks Amoxicillin 500 mg cap////3 weeks doxycycline 100mg tab ///e Prescription Rales, or crackles in your lungs, can indicate excess fluid in the lungs. They may occur with other symptoms depending on the underlying cause. Healthline advised that “bibasal crackles can be attributed to pneumonia bronchitis and pulmonary edema
” I have been producing quite significant amounts of sputum for a few months however while on 30 March respiratory physician Dr Sood referred to my “coughing up about half a pottle of mildly purulent sputum” and a recent diagnosis of pseudomonas he described my chest as “clear on auscultation”. “Bibasal crackles” were diagnosed at a GP consultation on 2 March 2023. In addition “Bilateral apical pulmonary fibrosis and scarring” was first diagnosed by Northland radiology in October 2014. “Stable minor scarring in the inferior division of the lingular segment of the left upper lobe and trivial apical pleural thickening noted bilaterally with no evidence of underlying adjacent pulmonary parenchymal scarring” was reported in by North Shore radiology on 5 August 2020.
I consulted with Dr Gentry of North Harbour Medical on 13 March 2023. He made no comment on the previous correspondence with Dr Thorpe. Despite a Labtests diagnosis of Pseudomonas Aeruginosa in February he seemed reluctant to prescribe but did so on the basis of advice of the respiratory physician who I will be meeting in late March.. The attitude seems to be unnecessarily pedantic particularly as I have such a long history of primarily gram negative infections. I was also provide with a renewed prescription of asprin . My blood pressure was 154/96 Gentry checked my lungs with a stethescope but there was no further discussion concerning either the lungs or the BP. I had requested a 30 minute consultation however this was aborted as Gentry advised that he had other patients to see.
I met Dr Groen on 23 May 2023. He provided a prescription for antibiotics doxycycline and ciprofloxacillin. He provided a referral for blood and chemistry tests including thyroid and lipids and sodium. He also provided referrals to the memory clinic and mammography.
PATRICIA WILSON.
In 2003 Patricia suffered a fracture in the sternum, probable fractures in her pubic bones and deafness in a car accident. She recuperated at home after spending 2 days in hospital. In February 2009 she had a serious fall which result in deep cut in her forehead –she had also banged her head on the concrete floor
Although there was excellent wound care at public hospital neither an x-ray nor a cranial CT was undertaken. Many international medical websites advise that in respect of the elderly a cranial CT is mandatory primarily because of the likelihood of submatomas in people of that age group. The CT would also indicate any skull fractures and highlight problems with the hearing nerve. Medline Plus a service of the American Institute of Health advises “that a skull x-ray is rarely used to evaluate head injuries or brain disorders” A skull x-ray ordered by mother’s General Practitioner Dr Crombie was essentially normal.
In early June 2009 my elderly mother fell against the wooden stair rail inside our home. An x ray of 4 June 2009 specified “approximately 10mm of anterolistheisis of L5 on S1. This is thought to be on the basis of severe degenerative facet joint change at this level………..there is moderate generalised loss of the veterbral height at the L1 level consistent with a compression injury…..lumbar films from 2005 report preserved vertebral body heights and therefore this is an interval finding”
We consulted with spinal surgeon Mr Hadlow on 19 June 2009 . His diagnosis was “ a compression fracture of the superior endplate at L1” He recommended “panadol medication” and advised “that it would take 2 to 3 months for the pain in her back to settle”. Patricia has received pain medication from her general practitioners Dr Crombie and Dr Ivori including codeine phosphate codeine oxycodone amtryptiline and tramadol supplemented with panadol and panadeine
In the interim we attempted to have an assessment at Auckland public hospital. The young ambulance officer queried the necessity for an ambulance and suggested that confinement to public hospital was a decision for the the general practitioner. We received much the same advice from the male head of triage when we arrived at the hospital. Mother had been admitted there in February of 2009 with a head injury. There were perhaps 6 people in the Emergency waiting room 2 of the more serious cases appeared to have been attended to. The gentleman from triage sat in his office for about an hour then consulted with mother and I –he advised that if we wanted to see the supervising specialist we would probably have another hour’s wait. Apparently no priority was to be given to an elderly eighty year old with severe back pain. Mother chose not to wait and returned home.
On 29 July 2009 mother attended spinal surgeon Mr Greg Finch .There were a couple of “committed” asides at the door prior to the start of the consultation. After checking the recent lumbar x –ray he appeared to dispute the previous diagnosis of Mr Hadlow in respect of the compression fracture and otherwise would not commit himself to a diagnosis pending an MRI scan. He doubted that a surgical procedure would be necessary. He did not check her earlier scans . A CT scan from 1994 reported “anterolisthesis with disc bulge and a possible compromise of the nerve”……… He did not discuss pain relief and when I asked him outside the consulting room he referred me to the general practitioner. His website quite clearly recommends alternative pain killers including Panadeine forte amongst others. I provided Mr Finch with some previous hospital and accident reports however he did not consult them.
Mr Finch’s report dated 29 July 2009 stated “ a little bit of weakness in the right S1 right nerve root and a little bit of dorsiflexion on the left …certainly has pain localised into the lower part of the lumbar spine….a little bit of wedging of L1… spondylolistheis based on the wear and tear in her lumbar at 5/1 level”
The MRI report dated 4 August 2009 reported “moderate to severe compression fracture of L1 with a loss of approximately 50% of height of the vertebral body…..moderate oedema within the vertebral body…..prominent narrowing of the T11/12 foramen on the left and compression of the left nerve root cannot be excluded…narrowing of the right foramen due to disc and nerve root compression is also difficult to exclude….grade 1 spondylosisthesis of L4 on L5…..The L5/S1m disc shows marked loss of height and signal intensity there is grade 1 spondylosisthesis of L5 on S1…..There is a compression fracture of T12 with prominent associated bone marrow oedema suggesting that it may be fairly recent. There is marked narrowing of the T11/12 foramina and nerve root compression is difficult to exclude.
On 1 September 2009 Patricia consulted Mr Gordon. In his report dated 1 September 2009 specialist Mr Gordon stated that mother “ had sustained a fracture of the L1..but the pain is lower down her lumbar spine than the site of the fracture might suggest. On evaluation she had a thoracic kyphosis and a list to the left-she was imbalanced in the coronal and saggital planes. Power was normal in all muscle groups of the lower extremities-sensation was normal in all dermatome areas and the straight leg raise test was negative. There was no percussion tenderness at the thoracolumbar junction….there is evidence of a compression fracture of L1 with this compressed approximately 50% and there is some retropulsion but this not causing any significant canal compromise.
I am somewhat mystified as to why the pain is in the lower lumbar spine when her fracture was at the thoracolumbar junction. Her daughter is somewhat convinced that her pain is coming from the lumbrosacral area and in particular the facet joints…I think it is reasonable to inject the facet joints at L5.S1…It is possible that the pain is coming from the L1 fracture and a vertebroplasty may be necessary but the pain is in an unusual location for this. I have referred her to pain specialist Keith Laubscher for evaluation and treatment and hopefully he may be better able to localise where the pain is coming from.”
An email dated from 21 September 2009 from Ms Good Mr Gordon’s Practice Manager stated “ Mr Gordon stated that the results from the steroid facet injection performed on Mrs Wilson indicate that her pain is not localised to the area that was injected. The little pain relief that she did experience was from the steroid component of the injection which would have acted all around her body and provided her with some relief.”
We had an interim consultation with Gordon on 25 September 2009. A brief aside from Gordon to his receptionist concerning “ lunacy” was overheard before the consultation. He has virtually discounted proceeding with further injections in the lumbar area at this time and has instead referred Mother for a selective root block procedure in T12 . The procedure was undertaken on 27 October but resulted in no alleviation of the pain.
In his report dated 30 September 2009 pain specialist K Laubscher stated in respect of the bilateral facet joint injection at L5/S1 “ she reports that her pain was abolished for about two days following that procedure-it is the lumbar pain that is her main complaint-she is tender to firm palpitation particularly over the right paralumbar region L4-S1 and extending into the sacrociliac area and around to the right iliac crest-it is possible that she has both an upper and lower lumbar focus. In relation to her lumbosacral pain it might be reasonable to try medial branch blocks for L4/5 and L5/S1 facet joints –if positive radiofrequency denervation might be an option” In his email dated 9 October 2009 Laubscher advised “that I have had a chance to look at the block sheet that recorded the response to local anaesthetic and cortisone to the joint. I had understood that the injection had abolished the pain for two days. This is not reflected in the “ block sheet .”
In his emails dated 13 and 14 October 2009 Mr Laubscher stated “ that the record sheet indicates that the level of pain was 7/10 following the procedure which means it did not numb the source of the pain. This is the most important time frame from my perspective. I had understood that the joint blocks had abolished the pain but it appears that they did not and that is the reason for the reconsideration of the options.” The pain level was recorded at 7 on a scale of 1-10 during the hours immediately after the procedure and then reduced to 4/6 for the 2 subsequent days. The only significant discomfort during those 2 days emanated from the injection site . Presumably that indicated that the steroid component of the injection was having some beneficial effect.
We again met with pain specialist (Mr Laubscher) on 26 January 2010. He maintained his previous negative stance toward performing medial branch blocks . Mother advised that she still has early morning pain which is most often very severe. Laubscher advised that the pain had to be of sufficient severity on the day of the procedure for the medial branch blocks to be effective and that Patricia might not qualify in this regard. At my request (and not of Mr Laubscher’s own violition) he examined mother’s lower lumbar region and it was fairly obvious that there is still severe pain when pressure is applied . She assessed the pain as 8 on a scale of 1-10. Upon departure Laubscher advised that the ACC approval for the medial branch blocks was valid for 6 months and could be renewed if the procedure should need to be undertaken at a later date. It is perhaps a matter of opinion as to whether Patricia has simply been the victim of a discriminatory denial of appropriate treatment.
A selective nerve root block for T12/L1 was performed by SRG Radiology on 27 October 2009. There was no reduction in the pain as a result of the procedure. In his report dated 16 November 2009 Mr Gordon stated that “ this lady still has pain over the pelvic rim on the left hand side ..she remains neurologically intact but she has a kyphotic flexed posture with a list to the left and her rib cage is inside the pelvis on the left hand side . She is quite tender in this area but palpating in this area does not exacerbate the pain that she normally feels. The latest injections exacerbated the pain but did not alleviate the pain in any way. if the root block at T12/L1 was not effective then medial branch blocks might be necessary. …a vertebroplasty would not improve her posture or improve her posture or improve her pain …the procedure would involve a major realignment of her spine to correct her kyphosis”
NCBI PMC: the US Library of Medicine NIH published an article by Professor Professor Huilin Yang and associates dated 17 January 2018: “Very severe osteoporotic vertebral compression fractures (vsOVCFs) are osteoporotic vertebral compression fractures with vertebral body collapse to less than one third of their original height. PKP (percutaneous kyphoplasty) is a safe and effective procedure for the treatment of vsOVCFs with spinal canal compromise, achieving significant vertebral height restoration and kyphotic angle reduction and leading to a significant pain relief and improvement in function. However, in vsOVCFs with spinal compromise, many authors considered these two procedures to be relatively or even absolutely contraindicated because of technical difficulty, high risk of cement leakage and further spinal canal compromise . Nevertheless, the literature and our own experience demonstrate this assertion to be unfounded.”
Some studies reported good results with PVP owing to its analgesic and stabilising effects in the treatment of osteoporotic vertebral fractures with spinal canal compromise In our study, to avoid perforating the endplate, a low lateral transpedicular approach was adopted and bilateral double balloon inflation was performed to achieve en masse reduction [23] in all cases. PKP is a safe and effective procedure for the treatment of vsOVCFs with spinal canal compromise, achieving significant vertebral height restoration and kyphotic angle reduction and leading to a significant pain relief and improvement in function”.
My mother attended at Kepa Radiology for a left wrist ultrasound. The sonographer, a Scottish woman who had performed by breast ultrasound also undertook this procedure. A brief aside namely “getting rid” was overheard from the woman as she returned to her room along the hallway. . ( The former owners of our property and subsequent neighbours in St Heliers were the Scottish Vicars family).
Subsequent to a further MRI scan Patricia visited Hand and Upper Limb Surgeon (Mr Tim Tasman Jones). H is report dated 26 November 2009 advised “ advance osteoarthritis of the radiocarpal joint lst CMC triscaphoid and DRUJ joints with almost complete loss of the articular cartilage and an associated synovitis involving the radiocarpal joints and long flexor tendons of the carpal tunnel. Importantly there are no signs of soft tissue tumour. I would recommend continuing to treat the wrist symptomatically with avoidance of loading intermittent use of a wrist brace and occasional use of ant-inflammatories. If her symptoms persist then I would consider a cortisone injection into the carpal tunnel.’
We again consulted specialist (Mr Tasman Jones) on 31 March 2010. Unfortunately On 31 March 2010 Patricia advised that she had decided against receiving a cortisone injection. . Tasman Jones made a rather unusual comment namely “ in the past people with carpal tunnel syndrome were place into a mental institution as nobody knew what was wrong with them” There seemed to be a measure of indifference about his attitude -he greeted mother when we arrived at his office –I was ignored and nor was there a free chair available – I had to remove an object from a chair nearby prior to moving it closer to the desk. We were not farewelled at the end of the consultation.
On 8 December 2009 we consulted with Orthopaedic specialist (Mr Barnes). He consulted only the plates of the MRI lumbar scan but not the accompanying CD. L1. His physical examination was confined to a light tapping in the upper part of the back. In his report dated 8 December 2008 he erroneously reported “ that Keith Laubscher initially performed medial branch blocks in the lower lumbar region” His report continued “ for the last six months she has had pain in the left upper gluteal region related to weight bearing and walking. This does not radiate. It seemed to develop after a fall. She has a severe kyphosis which is fixed and cephaled to the L1 vertebral body fracture with some loss of body height . There is no particular tenderness over the spine and she does not have lower extremity symptoms. I do not think she would benefit from either kyphoplasty or vertebroplasty procedures-there is no surgery which can benefit her in my opinion… she has also lost significant weight and has appetite loss….. she could possibly have an insufficiency fracture to account for her symptoms-it might be worth therefore ordering a bone scan to be sure there is no increased uptake around the sacroiliac joint-other than that I do not think I can be of further help”
When discussing the loss of weight and appetite (Mr Barnes) purported to be puzzled as to how kyphosis would impact on her food intake. He was unaware of anyone performing vertebroplasty in Auckland –there was no response when I mentioned that according to an internet site the first vertebroplasty was performed at Middlemore Hospital in 2004. He jokingly referred to the fact that “ ACC paid me a lot of money to see you” There was a “nut case” comment from his blond English receptionist as we departed.
We consulted with orthopaedic specialist Geoffrey Coldham and his report dated 16 February 2010 refers. Coldham advised “ she walks comfortably-she is kyphotic through the thoracic spine. There are approximately six inches anterior translation of her sagittal axis. On forward flexion fingers reach the mid tibia but she cannot extend to a neutral position. There is tenderness in the midline of the lower lumbar spine at L4/5 and L5/S1. Comfortable hip motion. Normal lower extremity power, sensation and reflexes . Distal pulses intact. Plantars are down going.. …asked me to discuss medial branch blocks. I advised that I have no experience in that area and cannot advise her with respect to that. There is no place for surgery in this lady….whether compression fracture is symptomatic and whether or not vertebroplasty should be contemplated… I will organise a bone scan . If the scan indicates isolated uptake around the L1 level I may refer her to Professor Doyle for consideration of vertebroplasty. If it shows diffuse uptake through the lumbar spine there is nothing I would recommend. I reviewed the repeat x-rays today. They confirm multi level degenerative changes in her lower lumbar spine. There is almost complete loss of height in the L1 vertebral body with 100% loss of height anteriorly and 60%-70% posteriorly with wedging through this area and focal kyphosis.
There was no discussion of either her weight loss or loss of appetite in respect of her kyphosis as has been the case with all previous specialists. Mr Coldham advised that he it was many years since he had undertaken a vertebroplasty procedure –he referred to kyphoplasty as being performed “ with balloons – and more expensive.”. He didn’t consider that any remedial physical therapy would serve much purpose. Dr Coldham is also a consultant with the Back Institute .
He did initiate another lumbar x ray which clearly indicated a worsening of the situation in L1. A previous MRI scan had reported a 50% loss of height which Coldham estimated had now increased to approximately 75%. Mr Coldham was apparently au fait with all our previous specialist consultations and occasionally seemed to reiterate details from their reports. In particular he repeated the recommendation of Mr Barnes that in view of the possibility of an insufficiency fracture a bone scan might be a possiblility. Coldham qualified this comment by suggesting that the scan would probably only be appropriate if mother was considering vertebroplasty.!
On 11 March we met with geriatrician Dr Scott.at the Greenlane Clinical Centre. Although we had provided x rays and scans she chose not to consult them. .She undertook an examination of Patricia’s leg movements and an examination of a section of her spine and stomach. She referred to Patricia’s early morning pain as “ a left upper quadrant ache particularly noticeable when she gets up in the morning worse on standing and overall much better than initially” She reiterated the findings contained in the MRI report pertaining to the compression /loss of height in L1 and the anterolisthesis in the lumbar/sacral area. “On examination she was kyphotic from about L1 but neurological examination normal in the legs, apart from absent vibration sense. She has allodynia ( pain to mild palpitation ) and hyperalgesia to pin prick over the T11 dermotome ( lower abdomen on the left just below umbilicus extending posteriorly over her lower ribs to mid line not tender over T11-12 vertebrae. T 11 nerve root irritation seems to best explain her pain” Scott disregarded kyphosis as being the likely culprit for her weight loss attributing it to stress. There was no recommendation for further investigation in this area.
She noted that a public hospital recorded Patricia’s weight as 68 kilos( nearly 11 stone) in 2004. She now weighs 57 kgs. Patricia is afflicted with hypothyroidism so any previous attempts at weight loss have proved fruitless. The matter of her spondylolisthesis and severe facet joint chondral loss and hypertrophy involving L4/L5 and L5 on Sl were not discussed.-Scott being more concerned with the compression and 100% loss of height in L1. Dr Scott was quite happy with Patricia’s treatment thus far and felt that there was nothing further that she could contribute.
In his report dated 10 May 2010 Pain specialist Mr Quin reported that Patricia had a “noticeable thoracic kyphoscoliosis”. He identified “the source of the pain as the point over the lower third of the left sacroiliac joint and this is tender to palpitation. She is also tender to the lumbosacral junction but has no spontaneous pain from that site at this time. There appears to be no neurocompressive disease or radiculopathy.” Mr Quin considered that Patricia “ was suffering from nociception from the left sacroiliac joint origin.’ He offered Patricia dec“ an office injection of triamcinolone and xylocaine into the subligamentous region below the long dorsal ilosacral ligament…or an x-ray guided sacroiliac joint injection at SRG” Patricia declined to proceed with injections at this time due to her concern about the side effects of cortisone injections. She was afflicted with a mild allergic reaction with flushing of the skin after a previous joint injection. Mr Quin also did not consider that a vertebroplasty was appropriate however he had recommended other patients to SRG for this procedure.
Patricia’s had a consultation with ENT specialist Dr Colin Brown on 14 April 2010 Subsequent to hearing tests Patricia was assessed as suffering from bilateral moderate to severe hearing loss. A recent CT of the brain and temporal bones reported “ mild to moderate age related changes in the cerebral white matter .No intracranial haematoma or other manifestation of head injury is shown. …the temporal bones show no sign of bony injury. The right middle ear and mastoid are normally aerated…..a small amount of fluid in the inferior aspect of the left mastoid but no sign of a fracture of the temporal bones on either side” Patricia was provided with hearing aids.
Patricia consulted with Dr M Butler an orthopaedic specialist assocated with the Pain Clinic at the Greenlane clinical centre in June 2010. In his report dated 24 January 2011 Butler advised “when seen 15 15/6/10 Mrs Wilson commented that on waking in the morning she had sharp pain in the left iliac crest region Grade 8-9/10 severity , after walking for 15 to 30 minutes ,Grade 6/10 severity, with slight tenderness and sometimes “almost numb” sensation in the iliac crest region, a long walk tending to increase pain. But no change with weather. She has had no L buttock or diffuse leg pain and has no present knee pain.
Management of musculoskeletal pain in association with spinal and peripheral joint osteroarthritis discussed, likely additional pathophysiology of a fluctuating postulated central neural sensistization disorder with elements of neurogenic inflammation ( such as flexor tenosynovitis at the left wrist) option acupuncture ( used as nerve stimulation technique) to the lower back and L leg used once weekly in a prone position with needles to the low back and L leg with 20-30 minutes minimal stimulation, occurring without break weekly for 10-12 weeks but with no guarantees as to outcome”
Patricia had earlier received acupuncture treatment in the lower lumbar area at Pilates. Unfortunately the procedure caused severe pain and was not repeated. Dr Butler did not consult any of the scans which we had brought to the consultation .
Subsequent to Patricia’s fall virtually nothing was achieved due to a combination of underlying attitudes, some variation in and the occasionally inconsistent opinions of specialists coupled with the latent reluctance of Patricia to proceed with steroid injections.
Patricia had another fall at home on 9 August 2010. She sustained injury to the upper part chest and the left knee.(a knee replacement was performed on this knee several years ago) As she was experiencing pain in the upper part of her chest when either breathing deeply or coughing her general practitioner Dr Crombie assessed it as a probable rib fracture . While she requested an x-ray of the knee she did not consider a x-ray of the ribs was necessary and it might constitute an over-exposure to x-rays even though this is about the third or fourth incidence of rib fracture.
In his report dated 16 April 2013 Dr Quin further advised “ on examination she has a severe kyphoscoliosis of the spine and she tends to be somewhat flexed habitus. She is tender over both sacroiliac joints but more on the left than on the right, but does not acknowledge any significant pain arising spontaneously from the joints. It was questionable whether bilateral office injections of subligamentous triamcinolone and bupivicaine would be of great use….suggested however that she should try taking Acupan 30 mg tablets three times a day for about 10 days ….if she feels that sacroiliac joints are contributing to pain , her daughter could bring her back and I would be more comfortable about treating her by injection”
Patricia had another severe fall in her bedroom on 2 april 2013. She was hospitalised for about 5-6 hours at the bequest of the St Johns ambulance officers. She was in severe pain with her shoulder and wrist . Unfortunately the lone female ambulance officer was also unable to lift Patricia off the floor and so had to wait for the assistance of two alternative officers including a female officer.. Subsequent to x- ray at the Emergency clinic in Auckland city hospital her clinical summary prepared by Dr Shyam sankaran reported “bruising around the right shoulder and wrist. Limitation of abduction to 50 degrees and limited flexion and extension. Limited wrist flexion and extension and lateral movement. Neurovascularly intact. X –rays showed no fractures. Given analgesia in AED . Discharged when able to mobilise and comfortable.”
As a result of subsequent severe pain and bruising an x ray was performed by Horizon radiology at White Cross Clinic Lunn avenue on 3 April and a splint provided . Patricia was attended by nursing staff , Dr Ekdahl and specialist Dr Rawlinson. A fracture was suspected and a cast was applied. The Horizon radiology report dated 17 april advised : “advanced osteoarthritis is present involving the distal scaphoid, 1st CMCJ, small joints of the thumb and DIPJ’S of the fingers. There is also degenerative calcification at the triangular fibrocartilage. In retrospect there was an undisplaced fracture across the base of the ulnar styloid and this is now clearly evident with mild bone resorption here. In addition there now appears to be a subtle undisplaced fracture distal radial metaphysis.”
On 24 February 2011 Patricia underwent a labplus test for Troponin. The test which is normally used as an indicator of acute cardiac ischaemia was reported as 60 ng/L * (norm (< 40). Higher troponin values are associated with increasing degrees of tissue injury and a worse prognosis. The test is normally repeated however that action was not undertaken in this case. Lab Tests Online state that “ Troponins are the preferred tests for a suspected heart attack because they are more specific for heart injury than other tests . Some people who have a heart attack will have normal troponin concentrations and some people with increased troponin concentrations have no apparent heart injury. Troponin levels may also be elevated with acute or chronic conditions such as mycoarditis ( heart inflammation) congestive heart failure severe infections, kidney disease and certain chronic inflammatory conditions of muscle and skin” It is unclear whether this test, which was requested by the General practitioner was onforwarded to the Cardiologist-it was not referred to in his report and apparently ignored. An Echocardiograph was performed at Ultravison Cardiac Imaging on 3 March 2011. Extracts from the report indicated “ the left ventricle is of normal (small ) size with SVEDD 3.8m and the LVESD 2. 3 cm……..there is a mildly prominent subaortic septal knuckle. There is good LV systolic function. There is a mild LV diastolic dysfunction seen as a relaxation abnormality. ……normal left atrial filling pressures on the day of the study. ….the left atrium itself is moderately dilated with a dimension of 4.7cm and an area of 31cm 2. The mitral valve is mildly thickened and calcified , there is a prominent calcification of the mitral valve annulus. The valve opens freely and closes with posterior leaflet mitral valve prolapse and significant probably severe MR . The aortic valve is trileaflet with the cusps are mildly thickend , calcified with minor restriction, they close without AR. There is normal Doppler velocity through the aortic valve at 1.2m/sec. The aortic root is of normal size at 3.6 cm. The ascending aorta is borderline large at 3.5 cm….the right ventricle is of normal size and systolic function. ………the right atrium is of normal size at 16cm2 .. there is normal Doppler velocity through the main pulmonary artery at 0.4m/sec and the interatrial septum appears intact. The IVC is not dilated and collapses appropriately with a sniff indicating no significant rise in right sided pressures” Comments> Severe mitral regurgitation from mild posterior mitral valve leaflet prolapse/////Normal LV size with good systolic function///////Mild TR with normal right sided pressures and unremarkable right heart.”.
Ellis’s general assessment contained in his report dated 14 March 2011 was “ an incidental finding of mitral regurgitation – I don’t think that Patricia has symptoms from her MR but I will suggest a further review in 6 months …to be sure by repeating the echo that the situation is not requiring a change in medical management such as frusemide.”
A subsequent report dated 14 March 2011 stated “ previously a prominent carotid pulsation had been noted and …..reviewed Patricia in 1994 and demonstrated a kinked right common carotid artery without any flow limiting stenosis. “Examining her today I found.. a weight of 60.3 kg a blood pressure of 164/86 when lying her venous pressure was not raised. Hearts sounds were dual with a 2/4 systolic murmur at the apex and her chest was clinically clear. Her resting ECG showed sinus rhythm a normal axis 69bpm with a right bundle branch block pattern. The right bundle branch block pattern has developed from 2001. At this stage I think Patricia has symptoms from her MR but I will suggest a further review in 6 months to reevaluate this and to be sure by repeating the echo that the situation is not requiring a change in medical management such as frusemide ( a diuretic)….what I think is an incidental finding of mitral regurgitation.”
A New York Times Health Guide advises that in respect of this condition
“Medications may include:
1.Antibiotics to fight any bacterial infections
2.Antiarrhythmics to control heart rhythms
3.Blood thinners to prevent clot formation if atrial fibrillation is present used for patients with chronic mitral regurgitation .
4.Digitalis to strengthen the heartbeat
5.Diuretics to remove excess fluid in the lungs
6.Vasodilators to dilate blood vessels and reduce the workload of the heart.
If blood pressure cannot be controlled an intro-aortic balloon pump may be used to help move forward into the aorta the main artery from the heart.”
If surgical valve replacement or repair is not an option the Mayo Clinic advises “Doctors are developing less invasive techniques to treat valve disorders, such as repairing or replacing mitral valves using heart catheterization techniques”
Patricia again consulted with Dr Ellis on 24 November 2011. Ellis reported : “ she was till able to walk down our corridor to come to the clinic room without difficulty certainly no shortness of breath or chest pain” In fact from my observations at home Patricia has difficulty walking as her balance is quite significantly affected and she appears to have a shortness of breath with a rapid intake. “ Her BP was 166/84 ….in the medium term Patricia might require an ACE Inhibitor as her BP was a little raised today but would only initially start a very gentle dose if her BP remains raised as I would not wish to cause any symptoms of postural hypotension” (Hypotension or a sudden drop in blood pressure occurs when a person stretches or stands up) Both of Patricia’s blood pressure readings are indicative of hypertension however her general practitioner Dr Crombie has advised that these readings are not the norm. ‘Her heart sounds were dual with a 3/4 murmur heard throughout the precordium and her chest was clinically clear –her resting ECG showed sinus rhythm with a normal axix,70 bpm with a right bundle branch block pattern.-….a cholesterol of 5.4 ( norm<4.0 mmol/L))….her troponin was normal at 9 ng/L –her BNP was reassuring at 17 pmol /L.”
BNP is a substance secreted from the ventricles or lower chambers of the heart in response to changes in pressure that occur when heart failure develops and worsens. Ellis seemed to be of the opinion that I had suggested mother be prescribed medication for heart failure “I have explained that that Patricia does not have heart failure and therefore the Digoxin anti-coagulants and vasodilators which Vicki has suggested are not currently appropriate” I had indeed enquired as to why no medication or even minor surgery had been recommended but I had never suggested heart failure as an alternative diagnosis to severe mitral regurgitation.” Ellis stated “ that a slight rise in troponin is not unexpected for a lady of 89 years with severe MR and does not signify any particular problem”-as opposed to the reading of February 2011 ( 60 ng/L * (norm (< 40).)
The Adult transthoracic Echocardiogram final report dated 24 November 2011 advised “there is an anteromedially directed jet as expected but there is also an important posteriorly directed jet that raises the possibility of anterior mitral valve leaflet prolapse too. MR limited to an assessment by color Doppler and LV dimensions” ( MR not fully assessed at this scan)
“Cleveland Clinic surgeons are pioneers in the development of minimally invasive techniques for mitral valve repair. Today, nearly all mitral valve repairs can be performed through a 2-3 inch incision on the right side of the chest. This approach may also include the use of a surgical robot, which allows an even smaller incision. Cleveland Clinic surgeons have been instrumental in the development and application of modern mitral valve repair techniques. Problems with the posterior leaflet are generally corrected by a small resection of the abnormal portion of the valve. Anterior leaflet dysfunction is managed by creation of new chords or chordal transfer. Anterior leaflet repair techniques are technically challenging, requiring a skilled and experienced surgical team to achieve the best result. All repairs include an annuloplasty, which is a complete or partial ring placed around the circumference (rim) of the valve.”
Patricia was admitted to public hospital on 30 July 2012 with diagnosed angina. ADHB report dated “ retrosternal chest tightness which radiated to the throat and left arm No SOB palpitation or waterbrush…no rise and fall of troponin-started on asprin and metoprolol. To use GTN spray for chest pain She has been prescribed asprin, metoprolol and nitrolingual spray. Had no more episodes of chest pain in the hospital.” Although her treatment was satisfactory mother was placed in the mens ward in general surgery where there was an elderly gentleman with a very noisy chest condition. Patricia is a light sleeper at the best of times.
In his report dated 29 November 2012 Dr Ellis stated “ Earlier this year Patricia was admited to the ACH with a prolonged discomfort in the chest. The troponin level did not rise, and the clinical diagnosis from the medical team was of angina although, going through her symptoms once more, I wonder in fact whether she had some bad reflux. I have started her on Lansoprozole on a regular basis from today”
Dr Ellis’s belated report dated 7 January 2013 advised “ the discharge summary of 31 July 2012 also noted T wave inversion in 3 and AVF new from her previous ECG-the ECG performed today showed sinus rhythm a normal axis, 64 bpm with a right bundle branch block pattern and t-wave inversion in leads 3 and AVF which is a normal finding. Going back through her hospital records I concur that the ECG of 30 July 2012 did also show that she had inversion in leads 3 and and AVF which were not present with the ECG of 24 November 2011 when the T-waves were upright. However these changes do not particularly imply ischaemia the degree of MR present and some slight LV volume change or other causes may account for these changes. …I think the addition of metropolol at a low dose and a statin is of help. Patricia had a height of 143 cm, and a weight of 59 kg and a blood pressure of 165/82 when taken by our Clinic staff. Her pulse was regular, venous pressure not raised, heart sounds dual with a ¾ murmur, and her chest was clear
Patricia underwent an echocardiogram on 23 November 2012 the preliminary report has noted a normal LV size with good systolic function posterior mitral valve prolapse as previously seen with severe eccentric anteriorly directed MR, severe LA dilation with an area of 33 cm2, but a normal right size and a systolic function and normal right sided pressures estimated form the mild –moderate TR. I think Patricia is currently stable. A review is planned for a year’s time.
DERMATOLOGY
We finally received reports pertaining to Patricia’s previous history from Dermatologists Dr Peter Gould. Only one report namely that pertaining to an excision in 2008 seemed to be in the possession of patricia’s practitioner Dr Sue Crombie. Reports were not provided to cover cryosurgery. Goulds covering letter dated 15 February stated ‘ as for her other consultations , these have all involved simple cryosurgery to numerous lesions on her face trunk and limbs over many years”
A Diagnostic Medlab report dated October 1991 reported as follows: “ SKIN LESION DORSUM LEFT ANKLE….the sections are of skin including partial thickness of dermis and show a cup shaped squamous proliferation with a keratinous core. There is some asymmetry. The base of the lesion shows a moderate inflammatory cell infiltrate which does not include eosinophils. Neutrophilic intraepithelial abscesses are not demonstrated. Although the appearances are consistent with an early keratoacanthoma, the alternative diagnosis of invasive well differentiated squamous cell carcinoma cannot be excluded on histological grounds. The lesion reaches the deep surgical margin Summary: consistent with keratoacanthoma.”
A Diagnostic Medlab report of March 2006 reported on a “SKIN LESION L EFT INNER ANKLE-CURETTINGS…..the specimen consists of a keratotic light brown skin nodule 7. x 6x 4 mm. Microscopy: the sections show a superficial biopsy of papillomatous skin. There is an irregular epidermal invagination with overlying hyperorthokeratosis and focal parakeratosis. The squamous epithelium shows mild hyperplasia and forms horn cysts at the base of the lesion. The surrounding dermis contains scar tissue and a light chronic inflammatory infiltrate. The epithelium shows no dysplastic change and there is no invasive malignancy in the sections examined. SKIN LESION LEFT I NNER ANKLE CURETTINGS: CONSISTENT W ITH VERRUCAL KERATOSIS.”
In November 2007 Medlab reported on a “LESION LEFT CHEEK: the specimen consists of a skin Ellipse 12 x 4 x 4 mm . No cyst is seen on section. MICROSCOPY: histological assessment reveals dense solar elastosis and mild perivascualar chronic inflammation in the dermis. No cystic lesion, significant cytological atypia or malignant changes are seen in the original or in deeper levels. LESION LEFT CHEEK DENSE SOLAR ELASTOSIS”
In his letter dated 26 June 2008 Dr Gould advised “ that he had excised the lesion on the left cheek on November 2007 the histology of which was reported as a dense solar elastosis. I have not seen the lesion recently however it has recurred and I presume it must be a squamous cell carcinoma or similar”
In his report dated November 2008 Dermatology registrar Dr Raj referred to the previous removal of a skin lesion from Patricias left cheek. He advised “ she had previous elective removal of a lesion on her left cheek in august 2008. Histology had suggested a squamous cell carcinoma with clear excision margins .On examination her cheek was unremarkable there was a small actinic kerastosis lateral to her left outer eye which was frozen today with liquid nitrogen there were no other lesions of concern.”
My elderly mother Patricia had 2 lesions on her right leg one of which was considered to be a probable squamous cell carcinoma. A consultation with locum Dr Bailey of St Heliers medical centre in early January 2012 resulted in the prescription of a bacterial cream bactrofan and antibiotics. As the result of a consultation with Dr Sue Crombie over a week later on 23 January 2012 a biopsy was performed by Labtests.
Their microscopy report dated 25 January 2012 advised “ skin lesion right lower leg – the specimen consists of a piece of skin 2 x 4 mm. Microscopy: sections show skin without subcutaneous tissue. A well differentiated squamous cell carcinoma invades severely sun damaged and scarred upper and mid dermis. Diagnosis: skin lesion right lower leg squamous cell carcinoma. Skin lesion right lower lateral leg : the specimen consists of three fragmented pieces of skin ranging from 2 x 1 mm to 3x 2 mm . Microscopy: sections show parakeratotic scale and unevenly thickened dysplastic epidermis with a small amount of underlying dermal tissue. The appearances are at least those of a solar keratosis. Invasion cannot be excluded.”
Mother had one consultation with a dermatological registrar Dr Lim in March and the excision/graft was performed by Dr Pillai ( consultant Dr Cranshaw) of General surgery on 10 April 2012. Patricia returned to Greenlane Clinical Centre on 19 April 2012 for the removal of the staples and dressing over the graft on the lower right leg. Removal of the staples was quite a painful procedure without anaesthetic and further stitches were removed at St Heliers medical centre on 2 May 2012.
In her report dated 26 April 2012 Dr Pillai reported that “ the graft site looked healthy and the graft has taken 100%”..Patricia was quite pleased with the outcome…Patricia’s daughter asked about reconstructive surgery for her mother…I explained why the excision needs to be taken down to fascia so as to avoid grafting on to subcutaneous fat…that at the age of 90 this reconstructive surgery would be major and unwarranted there will always be a lesser degree of indentation in the area ………Histology shows no residual SCC”
An alternative to grafting is the provision of a keystone flap A case history involving an 84 year old man with a SCC on the lower leg is de
The Keystone Flap for Lower Extremity Defects:
Mengjunan Hu BS and Jeremy S. Bordeaux MD, MPH2,*
Article first published online: 5 DEC 2011
DOI: 10.1111/j.1524-4725.2011.02236.x
© 2011 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.
Mother is 90 years old and not only was there a waiting time of three months but also a delay of approximately 4 hours on the day of surgery. Contrary to Dr Pillai’s assertion that “Patricia seemed to quite pleased with the outcome” she was quite alarmed at the depth of the excision She has been prescribed antibiotics ( synermox) by her general practitioner Dr Crombie.
The prognosis for grafting contrasts sharply with that of a flap procedure which has quick healing time, reduces pain and importantly also restores contour . At her age one might have considered the latter to be the more humane of the two options.
Patricia has been attended by district nurses for dressing changes since the surgery. They normally attend ( three times a week ) with the exception of weekends. By early June the wound had still not completely healed there was a small amount of greenish coloured slightly odorous discharge. Although reasonably attentive the nurses seemed reluctant to acknowledge either infection or the presence of 2 small ulcers on the edge of the wound which had been mentioned previously by a male nurse.
Unfortunately the misjudgement of a British nurse named Jan resulted a delay of 5 days before the dressing was changed. She had advised me by telephone that she considered that this was an appropriate course of action.
She did apply iodine to the wound in early June 2012 by which time the discharge seemed to have significantly improved. Laboratory testing of the swab on 12 June 2012 reported a “ heavy growth of corynebacterium species” with a recommended antibiotic treatment.
I had emailed a complaint to Donna Deans of the Quality department of ADHB on 4 May 2012 concerning the type of surgical procedure, the waiting time of 4 hours on the day of the surgery , the twice rescheduled date of consultation at the general surgical clinic to the end of June 2012 and the delay of 5 days between a change of dressing on the leg wound on one occasion by nurse Jan. I spoke to Ms Deans in June and she claimed to have no trace of the complaint.
We visited Greenlane clinical centre on 28 June 2012. Patricia was given a very cursory examination of the healing graft by a young male doctor Dr Toner while she was seated in her chair. He was not interested the laboratory report detailing the bacterial infection nor did he show much regard for the continuing soreness or the small amount of discharge still evident in the wound.. With regard to the lab report the consultant suggested that the heavy growth might only be indicative of a colonisation rather than a significant infection. He left Patricia with the option of continuing her care under the auspices of her general practitioner. She continued with a prescription of erythromycin .
She visited Dr Toner At Greenlane Clinical centre on 23 August 2012. Patricia is still experiencing discomfort in a small area adjacent to the the now generally healed leg graft.
A histology report dated 24 august 2012 stated : Wide excision of 2 lesions in April with grafting. The wound healed with a large crater and patient still has a lot of pain in medial border of wound where there is a tender raised hyperkeratotic looking area-concerning for a scc. On examination wound healed crater and base looks fine. Very tender ( not red) area on medial edge-raised irregular + hyperkeratotic.”
A punch biopsy was performed on “ a new lesion just at the inferoposterior aspect of the graft site”
Punch Biopsy Right Leg
Macro : a punch of skin 3 x 3 x 3 mm
Micro: sections show a punch biopsy of skin to upper papillary demis. The section is cross cut which hampers assessment. There is a well diffferentiated partially cystic squamous lesion in the dermis. In areas the squamous epithelium shows enlarged cells with abundant glassy cytoplasm and spongiosis. Scattered mitoses are identified. Within the underlying papillary dermis there are thin walled vessels and a scattered inflammatory infiltrate, in keeping with stasis. The lesion is insufficiently well profiled for a definitive diagnosis. Possibilities include keratoacanthoma, squamous cell carcinoma and epithelian inclusion cyst.
DIAGNOSIS: PUNCH BIOPSY RIGHT LEG: WELL DIFFERENTIATED SQUAMOUS LESION
Subsequent to biopsy histology report dated 29 October 2012 stated “ a resolving keratoacanthoma surgical margins clear”
At a consultation on 25 March 2013 Sue Crombie took a biopsy from the area of the ankle in Patricia’s left leg. There was some some minor swelling and pain above the area of the graft in the right leg in conjunction with a haematoma caused by a knock to the leg. Crombie didn’t consider that antibiotics were necessary .
A labtests histology report dated 25 March 2013 advised :
Specimen 1
“ Punch biopsy skin lesion left mid shin: the specimen consists of two skin punch biopsies each 2 mm in diameter x 2 mm in depth.
Microscopy: Sections show one fragment of focally ulcerated skin and accompanying fragment of adipoise tissue only showing medial calcification of vessel wall. Skin shows presence of an early minimally invasive well differentiated squamous cell carcinoma with superficial focal dermal involvement. Accompanying fragment of adipose tissue shows no tumour.
Diagnosis: Early squamous cell carcinoma.
Specimen 2:
Punch biopsy skin lesion left lower shin
Gross description: the specimen consists of a skin punch biopsy 3 mm in diamenter x 4 mm in depth
Microscopy: Sections show sun-damaged skin with epidermal features of a proliferative actinic keratosis. There is no invasive malignancy.
Diagnosis: Actinic Keratosis”
NEUROLOGY
Geriatrician Dr M Scott conducted a brief general and neurological examination of Patricia on 14 October 2012. Patricia’s “neurological examination essentially normal apart from cognition and impaired memory and fluency” Interestingly her “ visuospatial was 13/16” although she is almost blind in her left eye. “Her pulse was 60 bpm and her blood pressure is 120/60. Her PINP 42 was the the lower third of post menopausal range. A Ct head scan in May 2010 showed mild to moderate age related cerebral white matter changes as well as a small amount of fluid in the left mastoid- a repeat scan was not considered essential. It was considered that as Patricia is mildly bradycardiac her condition might be exacerbated by donepezil medication. She can continue driving albeit in a limited capacity. Pat is also seriously deaf and wears a hearing aid.
OPTHAMOLOGY
Patricia was afflicted with a with a probable spider bite on her right hand in October 2012 with the typical “bullseye” appearance which can be indicative of of a more severe bite. Patricia was concerned that her sight had been affected to some degree and she mentioned this to Dr Toner at Greenlane who didn’t seem unduly concerned as some of the bruising had disappeared. He prescribed her augmentin antibiotics. A tetanus injection and a referral to a local optometrist Mr Hirst were later provided by general practitioner Dr V Ivori.
An eye examination by Kerry Atkinson of Optometrists Mortimer Hirst on 31 October 2012 reported that “ in the left eye it looks like a central retinal artery occlusion which could be related to her health the recent spider bite or possibly giant cell arteritis” Atkinson onforwarded his report to Patricia’s former eye specialist Mr Donaldson and the eye clinic at Greenlane and Dr Crombie . I requested that he also onforward the images which he agreed to do. I also emailed both Atkinsons report and image to Crombie via her practice manager Kathy. Unfortunately at her consultation on 7 November Dr Crombie was unable to access the optometrists images and she was a little sceptical about the effect of a spider bite on the eye ( There are many similar complaints on the internet). Patricia was provided with a vitamin B injection as her levels were lower than usual .
Patricia visited the acute eye clinic at Greenlane on 7 November 2012. Unfortunately nearly 2 hours elapsed and she had still not seen a consultant. At 3pm I queried the delay with the receptionist who apologised and said she would ask the nurse to give Patricia priority. This never occurred. .
.A number of patients who had arrived later than ourselves had all been attended to and had departed. We decided not to wait and after a blood test departed at 3.30 pm. A young registrar conducting the clinic was observed making a quiet comment concerning sanity to the nurse. A British middle aged doctor with dark grey hair made a couple of rather loud comments concerning “ a bad patient” and “ the police as well”
Shortly after we arrived home I received a phone call from the staff nurse a middle aged woman with dark blond hair –she claimed to have been calling Pat’s name for triage which was certainly not the case . This is not the first time that Pat had experienced long delays in obtaining treatment including having to wait for approximately 4 hours for graft surgery –hardly the most considerate of treatment for a 90 year old.
In 2009 eye surgeon Mr Donaldson reported that Patricia’s “ uncorrected visual acuity was 6/20 for both eyes. She has astigmatism in the left eye and when this is corrected the vision in that eye corrects up to 6/6. Introocular pressures this morning 18mmHg right and left. I would recommend that Patricia have right cataract surgery.” A subsequent report dated September 2010 stated: “her visual acuity was 6/9 right and left . I have previously done a left cataract operation. She has nuclear sclerosis on the right side which is reducing her contrast on that side. Her intraocular pressure is 22mm Hg right and left “.
The optometrist’s diagnosis was refuted. .In his report dated 28 November 2012 specialist Mr Donaldson advised “ that her visual acuity is currently 6/15 R and hand movements L. She has previously had left cataract surgery . She has dense nuclear cataract affecting the right eye with a normal macula. The left eye as intraocular lens and a disciform scar at the macula. I think she would benefit from having right cataract surgery.” .
Cataract surgery was successfully performed by Dr Gray at the ADHB eye clinic on February 18 2013.
In his post operative report dated 19 March 2013 opthamology registrar Dr Cunningham advised:
“Diagnoses: 1.right cataract plus Toric lens insertion 18/2/13
• left pseudophakia
• left macular scar
Visual acuity: right eye unaided 6/12. 6/9 pinhole
• Left eye hand movements
Examination today showed the right eye was quiet. Her lens was well –positioned and on axis at 0 degrees. Her lens measurement was a 22 diopter and power with a 2.25 cylinder correction. ……new spectacle prescription “
GASTROENTEROLOGY
Patricia has been referred to the gastroenterology clinic at Greenlane. Her general practitioner Dr S Crombie received a reply from the clinical director of Gastroenterology at the ADHB dated 31 January 2013. He advised “ I note that Patricia had a successful fundopliction in 2001 as she was intolerant of PPI. This was a very successful operation but in recent months she has had reduced appetite and a recurrence of reflux symptoms. We will indeed place her on the waiting list for an upper GI endoscopy. She had a low risk polyp in 2004 on a colonoscopy performed in the private sector. There are no bowel symptoms other than a tendency to constipation and certainly no evidence of iron deficiency or anaemia. There is no indication to perform a repeat colonoscopy as there are no bowel symptoms. A single low risk polyp at the age of 81 does not confer a significantly increased lifetime risk of colorectal cancer.” After a lifetime of chronic constipation one would have thought that a further investigative procedure might be in order. Medical websites suggest that an alternative would be an MRI of the colon.
Patricia Wilson aged 91 years was first admitted to Auckland Hospital at the end of April for small bowel re-section surgery and again on 12 June 2013.. Unfortunately I was not contacted immediately after surgery by the operating surgeon Dr Jason Wong and eventually received later advice concerning mother’s condition from a clinician-christian name James. Patricia was shifted to the Awatea ward where apart from the nursing staff my only contact was Geriatrician Ms McMillan. There was an unfortunate comment concerning a “bastard mental case” overheard from a Maori person outside the ward. In addition a young male asian university student passed a loud comment in a crowded bus concerning “ Pat Wilson’s sacrifice”
The pathology report dated 30 April 2013 advised: “MICRO: The mucosa is atrophy with loss of villi and erosion. The submucosa is haemorhagic, oedamatous and acute inflamed.. The inerstitial haemorrhage and inflammation extends into the mesocolon. Acute inflammatory exudate is present on the mucosa surface. The resection margins appear viable . No thrombus is seen in the examnined mesenteric vessels. Features are consistent with haemorrhagic ischaemic enteritis”
DIAGNOSIS. SMALL INTESTINE –HAEMORRHAGIC ISCHAEMIC ENTERITIS
The operational report dated 1 May 2013 advised that “ the small bowel was adherent in the pelvis with a loop behind the bladder where the uterus used to be. There was a slight twist on this causing a small bowel obstruction. The small bowel was ischaemic with an area of early necrosis requiring a resection……The small area of bowel that was stuck in the pelvis with a closed loop of obstruction. …..A lower midline laparotomy was performed…..Features are consistent with haemorrhagic ischaemic enteritis”
Post-op low urine output
Recent fracture(wrist) fracture sustained following a fall on 2/5/13. The cast was removed and discussed with orthopaedics –she will be seen at the fracture clinic one week following discharge”
ADHB’s report of 28 May seemed to be somewhat contradictory – there was reportedly no sign of infection however the the wound was being treated with oral augmentin! One nurse advised me that Patricia had a stitch abscess. Another nurse advised me that a swab from the stomach wound assessed by Labplus indicated gram positive cocci. Large numbers of gram positive cocci were also reported by Labtests on 31 May 2013- “ large number of polymorphs and large numbers of gram positive cocci”. Culture: moderate growth of skin flora
After discharge from Hospital nursing/medical care was provided by Patricia’s medical practice and the district nursing staff.
Patricia was readmitted to Auckland hospital on 12 June and discharged on 14 June. The report of Clinician Nicholas Bryden advised “On examination: Obs stable, abdomen soft non-tender. Chest clear, heart sounds dual At the top of the wound there s a small opening with granulation at the base . No cellulitis.
Investigations: FBC nad, LFT nad, U +E nad, CRP 4 Swab –growth of staph aureus
Discharge medications: Flucloxacillin 500mg ( 7 days) and Paracetomol
IMP Slow wound healing
Progress and management : Admitted under general surgery. Wound was reviewed by the team and looked to be healing well.
Plan:D/c home///District nurse for dressings ///Analgesia////Antibiotics
Both Labplus and a Labtests ( 31 May 2013) reported large numbers of gram positive cocci.
Patricia met Dr Crombie on 31 May and 4 June 2013 after observation of the wound she advised that antibiotics would be required and prescribed augmentin. Nursing staff concurred that significant pus as a brown exudate was still evident in the wound . Assistance was also provided by district nursing staff.
I only became aware that the wound infection had been categorised as being infected with Staphylococcus aureus after reading the discharge summary dated 14 June 2013. Medical and nursing staff are very reluctant to discuss infection and the young male registrar who handed me the summary was non-committal. It is unclear as to when staphylococcus aureus was first diagnosed by Labplus or whether it could have been treated earlier with more potent antibiotics. .Her discharge medication was a 7 day script of Flucloxacillin and this has been extended.
By the end of June and despite nearly two month courses of augmentin and also flucloxacillin progress not unsurprisingly slow. It is particularly stressful for a 91 year old particularly since it only 12 months since she had a leg graft. District nursing staff attend on a daily basis and provide dressing changes excluding any topical anti-bacterial applications .
Patricia returned to the colo-rectal unit at Greenlane Clinical centre on 9 July 2013 where she met Janet a member of the surgical team. She examined Patricia’s stomach wound took a photograph and discussed it with her superior. It was suggested that Patricia return for a follow up in six weeks –she was also given the option of cancelling the consultation if she considered that the wound was sufficiently healed! Once again there was minimal discussion concerning the staphylococcus aureus infection in the wound. It was considered that continuing antibiotic treatment should be the responsibility of the general practitioner. A wound swab was also taken .
Patricia experienced nausea sickness and diarrhoea for approximately a week in late August 2013.She met a local general practitioner Dr Hazlewood on 23 August 2013.. A Blood pressure reading was 150/82? She recommended both a urine and faecal test.A mid-stream urine test performed by Labtests on 30 August 2013 showed “ no significant culture” A faecal test was not undertaken. The prescription was also provided for amoxicillin antibiotics.
Patricia underwent an upper GI endoscopy with Dr Mark Lane at Auckland Hospital on 6 September 2013. “findings: the examined oesophagus was normal. A large hiatus hernia was present . The nissen fundoplication is probably intact. The exam of the stomach was otherwise normal.. The exam of the dusodenum was otherwise normal. Impression: normal oesophagus fundoplication intact Hiatus Hernia. These findings account for symptoms however no easy fix…would require a re-operation not do-able given her age”
Lane suggested that the matter be left in the hands of Susan Crombie. He claimed to be unaware that Patricia had a bowel re-section in May and also claimed not to be familiar with the department of gastroenterology Mr Wong who actually performed Patricia‘s surgery in May. Dr Lane was also responsible for my gastroscopy in June of this year however he did not enquire as to my well being.
Pat visited Dr Sue Crombie on 24 September 2013. A B 12 injection was provided. We discussed Dr Mark Lane’s assessement of Pat’s recent endoscopy –Crombie didn’t really have an alternative opinion other than to confirm Lane’s status as a senior gastroenterologist. She didn’t discusss the likelihood of a laparoscopic procedure .
In respect of Pats weight loss ( from 59 kgs ( November 2012) to 47 kgs September 2013) Crombie seemed to be of the opinion that this matter could be dealt with by the geriatrician However I requested that Pat be re-referred to the colorectal clinic at greenlane and she agreed to send a referral there however as at 18 October no referral to the colo-rectal unit has been received.
The journal of Gastroenterology and Hapatology advises that in the treatment of older patients with hiatal hernia :
“It is reasonable to perform laparoscopic repair for a type 3 paraesophageal hernia in a relatively healthy older individual if the surgical expertise is available. However, close observation can be a reasonable approach in patients without complicated symptoms. As mentioned above, it is very important to recognize the signs of impending strangulation in a patient with paraesophageal hernia to surgically correct it and avert a life-threatening situation”
The lung CT dated 17 October 2013 advised “ There is prominence of soft tissue associated with a gastroesophageal junction which appears mass like although it seems more likely this simply represents compressed rugal fold due to the hiatus hernia.”
After experiencing two bouts of giddiness accompanied chest pain and breathing problems. Pat was admitted to Auckland Hospital on 16 October 2013. Dr Singh requested a chest x ray subsequent to a check by stethescope in which “ crackles” were evident. She was subsequently admitted to general medical on the sixth floor of Auckland Hospital. A female Indian doctor advised that Pat was probably suffering from heart failure and to that end they were attempting to reduce the fluid level around the heart by increasing the amount of frusemide. Patricia has been afflicted with a severe cough for the last few weeks which I suggested might be attributable to a bacterial infection as I had been diagnosed with Pseudomonas in September. The Indian registrar didn’t think that a bacterial infection was necessarily indicated in the chest x ray and that no antibiotics were prescribed at this time. Nor did she consider that a loss of appetite could be caused by a hiatus hernia.
The North Penn Hernia Institute advises “when intestine becomes trapped within the hernia the normal flows of food becomes blocked. This creates a progressive back up within the intestine and may result nausea and vomiting. If the intestine is only partially blocked nausea ( without vomiting) and poor appetite may be the result.” Likewise “ nausea vomiting or loss of appetite can result from a bowel resection” The following day Patricia’s nurse who had previously also advised that no antibiotics has been prescribed discovered that in fact one rulide tablet per day had been scheduled. Pat rang me early evening on Saturday 12 October to advise that she had become disorientated while walking . Nursing staff were advised.
CT of the abdomen and pelvis were performed at ADHB on 21 October 2013.
“CLINICAL INDICATION: Widespread malignancy on HRCT. Thought to be a possible lung primary.
Within the abdomen there is a nodule associated with the left adrenal which could represent an adrenal mass or left para aortic lymph node metastasis. 1.5 aortocaval lymph node is present and just below that level and neither of these lesions were seen on the previous CT from April. Inferiorly there are further enlarged retroperitoneal nodes and lymph nodes within the root of them mesentery . There is a paucity of an intra- abdominal and pelvic fat but the pelvic appearances are undermarkable with no pelvic or inguinal lymph node enlargement.
Liver parenchyma is normal with no evidence of hepatic metastasis. There is a solitary large gallstsone within an otherwise normal looking gallbladder. No biliary dilation. Unprepared study but there is no gross bowel lesion identified. Stapled surgical anastomosis seen within the left iliac fossa. The is no ascites. Pancreas, spleen and kidneys are unremarkable for age.
A wedge compression frature of L1 with degenerative spinal canal narowing ??? . No evidence of destructive bone lesion.
Opinion: Appearances remain consistent with metastatic lung cancer. A lymph node involvement in the upper abdomen and retroperitoneum with ??? easy biopsy targets in the abdomen and pelvis.”
Despite my request that an investigation be undertaken concerning Patricia’s symptoms including significant loss of appetite and weight it appears that nothing was achieved in this regard. Her hospital meals continued to be provided but were not eaten. The meals were occasionally supplemented by Fortsip a high energy nutritionally complete drink.
RESPIRATORY
An ADHB report dated 4 May 2013 advised “Post-op atelectasis and pneuomonia-treated with Augmentin and roxithromycin-chest x ray on 4/5/13. This is compared with previous day’s film. Similar volumes of free gas -demonstrated beneath the diaphragm with very distended loops of bowel still present. The diaphragms are elevated and there is atelectasis at both bases and small pleural effusions present. Air bronchogram seen behind the heart on the left indicating some degree of consolidation. The patient probably has a hiatus hernia as well.”–
Patricia had been experiencing bouts of vomiting mild chest pain and a prolonged cough and streaming nose. She attended Dr Govind of One Health on 22 September 2013 . An ECG was performed, which aside from a right branch block pattern was assessed as comparatively normal . A stethescope of the chest revealed some “ crackles “ in the lower lung and amoxicillin prescribed. Her BP was 110/? Patricia has been afflicted with severe coughing bouts in the past –however Dr Crombie has not been prepared to prescribe on at least two occasions .
After experiencing two bouts of giddiness accompanied chest pain and breathing problems. Pat was admitted to Auckland Hospital on 10 October 2013. A chest x ray was requested and Dr Singh advised that “crackles” were evident during his stethescope examination. Patricia was subsequently admitted to the general medical ward. A female Indian registrar advised that Pat was probably suffering from heart failure and to that end they were attempting to reduce the fluid level around the heart by increasing the amount of frusemide. Patricia has been afflicted with a severe cough for the last few weeks which I suggested might be attributable to a bacterial infection as I had been diagnosed with Pseudomonas in September and cross-infection would be a probability. The Indian registrar didn’t think that a bacterial infection was necessarily indicated in the chest x ray and that no antibiotics were prescribed at this time. Nor did she consider that a loss of appetite could be caused by a hiatus hernia
Patricia’s cough seems to be improved however she is still afflicted with a runny nose. It was unclear as to whether a throat swab or chest sputum samples had been taken for analysis. Once again a female African registrar also claimed that Patricia was not receiving antibiotic treatment. Patricia has been receiving additional oxygen . Her Bp was 100/?. The initial chest x ray indicated “ interstitial changes” and an HRCT was performed on 17 October 2013 which clearly showed extensive cancer in both lungs. One might have assumed that a CT of the lungs could have been initiated after the lung x ray of 3 April 2013.
A high resolution CT of the chest dated 17 October 2013 revealed: “extensive reticular nodular shadowing on the chest x ray. Extensive bibasal lung nodularity with nodular interlobular septal thickening consistent with lympangitis carcinomatosis. Interspersed among the areas of interstitial thickening there are small nodules which are more predominant in the lung bases. Peripheral areas of consolidation are present in the lingula, but medially adjacent to the mediastinum in the right upper lobe there is a more spiculated mass like area of consolidation. Enlarged mediastinal lymph nodes are noted, the largest a subcarinal node measuring at least 2.2 cm short axis daimeter. Paratracheal adenopathy is also noted exending to the base of the neck, note it is measuring up to 1.8 short axis diameter. A Left supraclavicular node measuring 13mm short axis diameter is also noted.

There is trace of pleural thickening at the right base but no pleural fluid or pericardial fluid identified. The heart is not particularly enlarged although the cardiac valves are somewhat calcified.
The adrenals are normal. Small portion of the visualised abdominal organs are unremarkable. There is a left para-aortic node measuring 16 mm short axis diameter just medial to the left adrenal gland.
Bones: Gross degenerative change invloves both shoulder joints. There is sclerosis of the right posterolateral 6th rib without destruction. No other discrete bony deposit seen.
Comment : Overall the conglomeration findings within the lung also associated with adenopathy favors malignancy; The lesion in the right upper lobe could represent a lung primary. Lymphoma is a possibility given the adenopathy. There is prominence of soft tissue associated with a gastroesophageal junction which appears mass like although it seems more likely this simply represents compressed rugal fold due to the hiatus hernia.
18 October 2013 I met registrar Louise and consultant Dr Hotu. They discussed the CT chest scan of the previous day which indicated significant lung cancer. There was no explanation as to why further investigations were not instigated in May 2013 at the time of Patricia’s last chest x ray. Huton suggested that changes in the lung can occur rapidly in a matter of months. She suggested that needle biopsy could be attempted although it was optional. She was of the opinion that oncology would first need to be presented with biopsy results before consideration could be given to admission to the oncology ward. Huton did not recommend a consultation with a respiratory physician but seemed to think that palliative care was the best option. Patricia had been a smoker but stopped in the 1960s. Such extensive (primary?) cancer seems to be unusual for a long-term non smoker . A chest x ray was performed by Mercy Radiology in February 2001.
Website Radiopaedia advises that “Lymphangitis carcinomatosis is most commonly seen secondary to adenocarcinomas such as: breast cancer – most common 3 //lung cancer (bronchogenic adenocarcinoma)//colon cancer////stomach cancer
It can also be seen in numerous other primary cancers, e.g. thyroid cancer, laryngeal cancer, pancreatic cancer, cervical cancer and prostate cancer.
Spread into the lymphatics in most cases (except in bronchogenic adenocarcinoma) usually occurs following haematogeneous seeding of the lungs, with subsequent lymphatic involvement 1,3. Both the peripheral lymphatics coursing in the interlobular septa and beneath the pleura, and the central lymphatics coursing in the bronchovascular interstitium are involved 2.
Histologically tumour is seen both within lymphatics and in the adjacent interstitium, with associated oedema and desmoplasia”3-4.
ADHB website advises that “ Once lung cancer is diagnosed, a process known as staging determines the extent of the disease. Knowing the type and stage of cancer means the doctor can plan your treatment.
Different treatment options include: surgery. The type of surgery depends on the size and type of cancer// radiotherapy is a form of high energy radiation (X-ray) that kills cancer cells// chemotherapy is the use of drugs aimed at killing cancer cells.
The aim of treatment is to keep the person as well as possible even if the cancer cannot be cured.
If you have a lung cancer there will be ongoing follow up with specialists and nurses throughout treatment and afterwards
Patricia was discharged from hospital on 25 October . She was provided with oxygen equipment for use at home however her breathing was generally laboured. After her return home she had been experiencing giddiness including occasional problems with her eyesight (seeing wavy lines) and extreme general discomfort including the chest.. She said she felt as if “ she was going to die” She had to be assisted to and from the the bathroom and lavatory. She was readmitted to hospital. I visited the hospital and ward 21 (planning unit) on Labour Day 28 October 2013 however details from the nursing staff were scant .
I enquired of Nurse Eleanor? ( a british nurse) as to whether Pat was receiving antibiotics She advised that they had not been prescribed as Pat did not have a temperature! I was not aware that a lack of a temperature would preclude an antibiotic prescription. Patricia was formerly prescribed antibiotics in the general medical ward to where she had once again been returned. I have been afflicted with severe chest and sinus infections and most often my temperature is classified as normal.
It appeared that she was only receiving one tablet per day which was probably inadequate. I collected a pottle of golden coloured sputum from Patricia which was handed over to the ambulance officers and presumably onforwarded to Labplus . I spoke to the senior nurse Rowena on 31 October and she advised that the sputum test initially showed the presence of some bacteria and was awaiting a culture. I also later spoke to the gerontologist Dr Spriggs concerning the sputum test results. He seemed to be singularly unconcerned and considered that providing antibiotics “would be a waste of time.-that Patricia was at the end of her life” The clinical summary dated 25 October “ thought to be heart failure vs atypical chest infection-thus given IV antibiotics”
Pat has been re-admitted to the general medical ward on 29 October 2013. We again spoke to the female Indian house surgeon who we met previously in ward 65. It seems that the status quo is much as it was-Pat has not yet been prescribed antibiotics “ because she doesn’t have a temperature”. !
The question of Pats serious loss of weight and appetite was not addressed during the previous 2 weeks in hospital . I had hoped that there would have been a further investigation of the bowel re-section in conjunction with the hiatus hernia.
She was no longer seemed able to walk on her own. She has also given up reading and listening to the radio .She previously would read the newspaper for 2-3 hours in the morning.
I visited Pat in hospital on 1 November 2013. According to the nurse Pat had her usual breakfast of porridge earlier in the morning and had put on her makeup. . When I arrived she was in a semi-comatose state unable to open her eyes and sounding distressed and groaning loudly. She was barely conscious and was shifted to another ward where she was alone. At one stage she pointed to her left side and again said “ she was going to die”!
There was no further medical investigation concerning the latest symptoms. She was given morphine by the nurse, a Pacific Islander, which seemed to quieten her down. I provided Patricia with ginger ale on the end of a small sponge . This action elicited some response for a time until she gave two gasps and ceased breathing. Her head was tilted to the side and her tongue was protruding slightly from the inside of her cheek. It would appear that she may have died from a serious heart attack/and or stroke. Dr Lm visited her about an hour and and a half later and confirmed her death. Her death certificate stated “lung cancer months –cognitive impairment years”.
In June 2018 I received a hospital summary for the period 27 October 2013 until her death on 1 November 2013. The summary is as follows:
“ A swab growth of Staphylcoccus aureus” was reported in a discharge summary of 14 June 2013 and a “7 day prescription of Flucloxacillin . Recent admission with small bowel obstruction 30/4/13 complicated by post-op atelectasis and pneumonia and then required a period of rehab.
Laboratory test for P Sexton 27 October 2013. “Muco-purulent large numbers of gram positive cocci seen- large numbers of gram negative bacilli seen
Culture: a moderate growth of mixed oropharyngeal flora///gram negative organisms (mixed species) ////at least three different organisms present” ( Al Anbuky)
‘Patient watch report 28/10/13 “pat said her spinal hurts in pain so as her chest told the nurse about it”// marked systolic murmur MR: respiratory scattered crackles : fine crepitation throughout lower zone//sputum mucopurulent large numbers of gram positive cocci and gram negative bacilli//Daughter visited very concerned that pat is not on antibiotics..?? explained docs plan”
A Medical internet site advises “Marked variability of systolic heart murmur associated with idiopathic hypertrophic subaortic stenosis. Variation in the severity of left ventricular outflow tract obstruction in response to physiologic and pharmacologic maneuvers is characteristic of idiopathic hypertrophic subaortic stenosis (IHSS), and useful in distinguishing it from other types of cardiac disease.‘,
Medical journal Circle states: “Idiopathic hypertrophic subaortic stenosis (IHSS) is a disease characterized by marked hypertrophy of the left ventricle, involving in particular the interventricular septum and the left ventricular outflow tract.”
Review of the literature indicates that sudden death occurs in a significant proportion of patients with IHSS and appears to be more frequent in those with the familial than in those with the nonfamilial form of the disease. It may occur in patients who were previously asymptomtic as well as in patients who had been severely limited prior to death.”
29 October 2013 “Pat woke at 0500 with slightly increase resp rate speaking in short sentences productive cough with greenish sputum given a hot drink.///Obs within pats usual range before 1300 hrs but RR went up to 40 beats /min while c/o chest pain soon after daughter left. Pat claims she is scared wanting daughter to come back to support her-no one answered home phone”. The greenish sputum would have been characteristic of pseudomonas aeruginosa.
The US National Institute of Health advises “ in Lung cancer patients are characterized by the frequent presence of Pseudomonas aeruginosa in chronic obstructive pulmonary disease, together with age-related comorbidities, aggressive tumors and rapid clinical
In his report dated 30 October 2013 Gerontologist Dr Spriggs reported: “ This 91 years old lady went home just before the long weekend and came back after a couple of days. I think because her daughter found her more short of breath. We had a discussion with Mrs Wilson and her daughter on several occasions about the cause of the shortness of breath. It is due to lymphangitis . We are not going to be able to fix it”.
31 October 2013 Assessment summary: “Mrs Wilson has had a recent admission (discharged 25 /10/13) and it is felt she returned as her daughter was concerned about her breathlessness.”
In fact I had readmitted Patricia because of her complaint about the pain in her chest.
1/11/2013 Notes from Dr Lim: “Pat currently deteriorating may pass away in hours/days. Daughter asking for details of sputum culture. /Vicki would like her mother to be treated with antibiotics -explained that she is unable to swallow in her recent condition and to put in an intravenous line would be cruel and inappropriate : sputum culture Nil infection” ??
There is no reference in the nursing or medical notes on the day she died to Patricia’s obvious extreme discomfort in her chest or the fact that she was obviously groaning in pain and complaining that she was going to die. It might be construed that Patricia died of a heart attack complicated by acute respiratory distress caused by a lack of medication.
CONCLUSION
Whether this saga of unprecedented victimisation which involves discrimination evasiveness and disregard might also be assessed as involving serious negligence and criminal intent has yet to be determined. Duplicitous infiltration/substitution might also another significant factor to be considered.
The entrapment of totally sane individuals with diagnoses of insanity in order to use them for experimental purposes, in effect treating them like monkeys in a laboratory, is not only blatantly criminal, if not indicative of fascist eugenics , but also seriously undemocratic. It seems to represent nothing more than a terrible role reversal where in an oppressive society the totally sane but politically unwanted are incarcerated or otherwise disposed of and the socio-psychopaths are left to run the asylum, so to speak.
Any assistance which could effectively end this long running odious saga and prevent the disposal and dispossession of a suffering pensioner would be welcome. Please contact me @ jazminnex4@gmail.com particularly if you can provide any financial or legal assistance. Images and family photos are also available on my Facebook page.
GENEALOGY
Genealogy might also be relevant. My family is descended from Emily Hilda (Wallis) Wilson who in turn was descended from Emily Sarah the daughter of Captain Thomas Wing. Another relative namely James Wallis helped to establish the Wesleyan Mission in North Island and was a signatory to the Treaty of Waitangi.
Wing was a former harbourmaster of Port Phillip in Melbourne and the Manukau of Auckland New Zealand in the late nineteenth century. Captain Wing handed down lockets to his offspring. Wing also had a daughter Fanny by the sister of Chief Tutu. The little girl was apparently killed in a raiding party by Hone Heke in Russell where she was living with the Tapper family.
The partial tracing of an almost identical image of the locket which is inset into the wall/ gate of Wingfield Castle Suffolk was made by a relative some years ago. That is the only tentative connection between the Wingfield and Wing families known to us. Wingfield Castle was the ancestral home of the Dukes of Suffolk –Wingfield is their family name.
Mr and Mrs B Wingfield and their son and daughter lived in a nearby street in Karori Wellington in the 1950’s and 60’s. We had only very limited contact with the family. Pippa (Glanville) Blake, the wife of my cousin former yachtsman Peter Blake ( deceased) is also descended from the Wingfield line as is the Duchesss of York. Photos of the locket, a copy of the tracing , together with photos of James Wallis dated 1860 and Wingfield Castle are enclosed.

British Author Laurence Gardner used his books to propose several theories, including a belief that Jesus and Mary Magdalene had married and had children, whose descendants included King Arthur and the House Of Stuart, British kings, and families including the Wingfield family.

AN ADDENDUM TO THE VIOLATION OF VICKIS NZ HEALTH HUMAN RIGHTS
A summation of general derogatory comments most of which have originated from an Asian shortwave station and conveyed to me via remote viewing tactics is detailed below:
Comments specifically pertaining to NZSIS staff are as follows:
Evil! (Scottish NZSIS male staff member Mr IS) /evil has been knocked off/// ///Maybe its because she is a wog” ( female staff member Miss PW- NZSIS) “the inappopriate prostitution of a female staff member to an FSB officer for debased sexual encounters” ( internet) ////// “She is a nut case and can’t stay here” (senior British staff member Mr CD- NZSIS)/// “everybody is fine except for that ?? next door” ( a tall young man from the NZSIS surveillance team-possibly Mr T chatting to an office colleague)///// “LB is getting rid”( general practitioner at Whangarei A & E medical -referring to a former police officer and NZSIS staff member) ///Discussion concerning “ LB” involving young middle eastern group on the Auckland North Shore)///// Reference to “LB” from the manager of my storage unit at Raumanga// “LB is arresting”( a quiet aside from Dr Hedlund of Bush Road Medical practice Kamo) A reference to “LB” by a Pak n Save staff member while on the phone in the store.///// “LB told us to watch nut case” RV- Police officer. // “Natalie said these are our signatures on Warren Peche’s”//// ( Peche was a former resident of Amapur Drive Khandallah )// “Natalie made a mess of situations overseas” ( unid female)”Benseman(DSIR) did an analysis for the NZSIS” ( unid female) // “ the lies of Mr JB” ( a Kassler niece) /// “The NZSIS have details of descendents” // the involvement of The JB family/////”Vicki killed LB” (LB) and “LB says its nasty pictures” senior whangarei police officer (RV) ////further sex with PW in the Lady Norwood Rose gardens/////Mrs Bone committed Vicki ///discovered in Q branch-a directive to ASB///// LB seen meeting Tanya Lankovsky//////
NZSIS don’t like complaint///discovered Chris was a ruthless sadist ( poss ref to male staff member)////details about brave from NZSIS staff////pressed a secret button and reports? dropped out)//////LB delivered Vickis papers//you will never know/////JE seen meeting soviet embassy/////Mrs B told everyone she was a misfit/////JB has a suite -videos clients/////the leader was CD///////PW started doing cartwheels /stole his map//// FBI said how did this old nut case get into NZSIS//FH also worked for NZSIS didn’t stay////Insistence of JB////the reason is something in JEs back-ground (psychology major)//////something in CDs file about the 1960s-when changes were made-details of evil starvation////NZSIS targeted young women from the line ( British gent)//JB gave the impression she was a weirdo///why Simich watches//// JB spent time in jail-stole money///Mrs JB has a list of young girls///
/Bone says she has to be assaulted///JE ran a campaign against women and girls///LB said it’s a measure////IS has gone -left the house on the market///LB discovered she was used as a child///ditsy -warehouse ( 2 young men with phones standing in Elliot st Auckland city-surveillance staff)///Israel reckon its RD/////LB sacrificed women from the line/////Mrs NK sacrificed a fami-ly/////the reason for the sacrifice why PM left/////destroyed by CIA/////JB meets the Mengele family////NZSIS has an account in a Russian bank/////PW has NPs private number///DG will have to take over( British woman)/////JB seen running around with young women//////Its UB-said its because I said so ////// ( Ms L Admin)/JB related to Himmler ///NZSIS has sex with the Kasslers////why this visitor has to get rid of ( poss JE)////British frater…her fate ( poss JE)///JE said she didn’t resign//nzsis going from bad to worse//// vicious conversation involving NZSIS received by Al Jazeera//////MI6 said certain details//// Late July 2020: womens group poss including JE///why NZSIS subject of a criminal enquiry// PW sent somebody to shoot Nick P///////LB discovered staff transcripts///LB said get out its sinister US///There is money ( poss JE)///RB can’t allow that-harassment from PB//////// ////JE says you have old stuff///found CDs secret cache////
/hidden under boards in JB?s house////JE on tape-deliberately engineered////you didn’t realise there was a lawsuit ( poss JE)///NZSIS taken Bruces lawyer in for questioning//Simich met Megan ( JE?)///Simich asked JE to investigate that mental case///JE ran assassinations///NZSIS taking kickbacks (Asian male passerby)//JE meets Satan ( Maori female)//debased Simich ( JE)////discovered what LB was lying about//that liar was IS////JE broke into bananas//////think its Elizabeth ( JE//)//this knife cuts ( Russian gent)///she didn’t resign ( poss Cathy )///also JE///Christine lied ( poss ref to Mrs LB/////why I set up ( JE?)//JBs wife and daugters//why JE chose (JE)///JE said it’s a trial///doctor waiting on assessment of JE///NK had a list of experiments -you were on it/////NZSIS has to make Vicki leave (JE?)//comments JE and female companions -Clezy( CEO Haumaru) said JE will have to ///discovered ID of NZSIS officer//Nottingham used to meet NK?///Dacre can’t represent (JE)///JE tried to impose an impediment//committing(JE)///something not nice in JEs background///CD? has secret ceremonies////did LB meet Fisher//NK had a directive from Riyadh///Mrs Simich said what will be imposed ( JE?)//Ann Simich had the transcript handed to her by JE////its securitys orders///seen LB standing by a tree////Mrs JB caused a murder////This is JE ( female bathroom)women getting deadly drinks-details with the Germans and JB////where you will go (JE)////Dacre rang JE////something in CDs background//its CD////
LB discovered why she is being knocked off///JB quickly disappeared//LB is an assassin ( RNZ)////LB said its official///discovered an assumed id///LB says it’s a bombshell///CDs psychiatrist said she was a diagnosed weirdo//MI6 discovered the id of Pat and Alan Wilson in an FSB file//// //discovered RB a murderer///a very dangerous lesbian in service///Mrs LB caused a debacle////CIA hid something//Felicity said surveillance a terrible man///NZSIS paper about the case given to the German////Its Beria/////LB wants to assess you mentally//JB visited Melitia has sex papers////why Vicki losing independence ( Poss JE)////Police watch Its JE/////Dacre said I have met JE/////discovered its Moorhouse ( British gent)////Its evil JB///Ann Simich seated beside JE///// Video of CD in drag///the Kasslers are useful tools ( Russian gent)///Mrs JB ( young women)///NK didn’t like old Mrs Wilson///you will get hurt ( poss JE)//Mrs LB said its most necessary///LB said she is not sick///Nick Parshenko told the neighbours that the NZSIS had a mad woman on the staff//// mental health met the head of NZSIS//LB took money////LB is a trained assassin///NZSIS staff spread rumors around the city//Why Mrs LB visited GP/// JE going to do in Vickis brain/doesn’t like medication///why Shipley has been selected for torturing ( Poss JE)//JE? Visits vicious Satan////JE also cited Vickis stomach////IS seen meeting FSB////
JE wants to see what she does//this is the evidence of smart Molyneux///Simich said Molyneux convinced////NK? Rings a lesbian ring//Mrs Simich said why there wont be any more antibiotics (JE?)//Mrs LB rings the police///PW meets hell ( American speaker o RNZ)///this is Nick Parshenko//the Kasslers are useful tools ( poss Mr Parshenko)/////Miss Kassler meets JE////Mr Begley was a friend of JE///LB says its nutty//NZSIS said Vicki wont get out (JE)//JB finally getting rid (British gent)///comments JE and Kassler niece//NZSIS destroyed your complaint ///Unit 8 rings NK////Took JB in for questioning told a terribe lie///why you have been framed ( strident sounding female)//Nick Parshenko very determined-waiting ( unid female)//this psychiatrist thinks Vickis mental ( Russian gent)//JE hired dangerous weirdos///why did JB meet hospital//Its Linda///hit D…k ( RNZ)//JE has another identity//Molyneux sacrificed her ////they were switched with Russian treachery///millions in NZSIS account from an Italian source//LB discovered something horrifying in the Simichs///LB said this case went with G Clezy of Haumaru///complaint from CIA with Clezy////LB and NK -torturing and knifing//JB discovered secret contamination/where Vicki will have to put pussy ( Russian gent)///details of an idiot with JB///it’s a dangerous territory ( Russian gent)//British might take you in a warship ( Russian male)//something visits JE ( Russian gent)///JE doesn’t like Prince Michael///NK thinks its encrypted ///NK thinks is a saga of erratic behav-ior///JE destroyed your initiative//something in CDs file -traced back to Pat////JBs wife causing trouble///JB caused a debacle -earlier experiment///Hesse-JB -scottish nazi party ////CD…FSB -why FSB insistence//securitys (secret) polygraphs indicated lies ///NZSIS hid something about Pat //polygraphing of NZSIS staff indicated lies///Its ? PW ( British gent)//blamed NK//// JB responsi-ble//documents found in RCs cupboard//LB prone to embellishments about ladies//Mrs Bone going to force a breakdown//Houstons last contact was RC//////Its what O CD ( British gent)//JB started lying to the police //JT selected the Wilson family//JE and the Russian ( my bathroom)//
Haumaru met RD ( Maori female)//LB has been sent //JE gave your program//Mrs JB/////something alarming in Bruce’s history participated in destruction of a young woman in NZSIS///NK said its Vickis rote learning//JB met scientific ////Christine B again meeting Vickis GP/////LB gave Simich carte blanch to take furnishings//CD said NZers will run for their lives ////comment Scottish? Psychiatrist also Kassler niece we don’t like Vicki saving money///RB discovered a Russian émigré hidden in the Kassler family///CD meeting Al Qaeda today///NZSIS had a shocking monster in the staff/RB getting large payments from Arab source//Ann Peko said Pat let something slip-relayed to NZSIS////LB sacrificed a beak (unid male)/PW blackmailed Alan ///LBs wife visits Vickis GP////LB said something bad happened -why Haumaru getting rid//LB is going to push Vic around///Did Vicki make a mess of it ( poss JE)/// LB said she will crack ( G Reid)///discovered de-scendent files in security//LB said it’s a nasty lawyer.////you don’t realise its cruel DG////NZSIS staff imposed changes on family///JB seen entertaining FSB staff//JE visits serpents//IGIS called RB a liar -investigating his finances////Its LB ( tall silver haired male patient at Labtests)//JE tod the Kasslers that Vicki was descended from Christs line//////salient details about CD//comments poss JE and Maori female companion-Mrs Simich causes trouble//CD conspired with Mission Bay//JE says its serial pottiness//JE doesn’t like it online//JBs experiments //IS’s son standing around telling everyone she couldn’t do jobs//something terrible in CD’s//wishes of JB ( British gent)//LBs wickedness//JB got into trouble//JB has weird predilections activites with the Kasslers//Its spy CD//NK said it’s a terrible stink//comments from JE and British gent//RC meets tenants// tenant sent enquiry to admin NZSIS//NK caused a debacle//LBs wife makes repeated visits to Vickis medical practice//NK deliberately lied about a staff member //Mrs B keeps phoning//Nk used an old car -what is hidden in car//NZSIS -why they had to hide it ( American gent)//JB said we have incarcer-ated her///Mo Kassler sent GT//insistence of Mr B////NZSIS paid a priest money//Kassler said she has strange thought patterns ( Kassler niece)/think its JBs daughter// Hidden in Dr Cunninghams car was a request from an NZSIS officer///Its sloth ( poss JE)//somebody in NZSIS collected a packet of rubbish// something shocking and terrible hidden by the staff//NK caused a debacle//LB said Vicki ’s had it//Instigator was JT( British female)/JE tried to finish off //GT ran experiments in Karori//NZSIS pressing charges ( female police officer?)//JE told the police to take a butchers ( British gent)//JE said she goes away ( unid female)//NZSIS documents in Simichs//NZSIS started destroying Alan in Treasury ///Kassler has a trauma file ((unid female)//LBs daughter giving instructions to ASB//NZSIS putting ditsy on trial //didn’t sus ditsy ( Hillary Barry TVNZ)//reason for pressure from NZSIS ( poss JE)/// you don’t belong here ( JE)//Mrs Simich said you wont go ///old Asian tried to jump off//Mo Kassler fell down the fireescape//the Kasslers didn’t like Vickis earlier scholastics..forcing an impaired brain//Bruce isn’t going to hand over that money//why you will be led away ( unid female)//what did Ann Simich do ( young woman o n Raumanga bus in Whangarei)////you are going to a mental home ( young man poss police officer)//the machinations of 3 psychiatrists//where blood is spurtin///beloved child selected for a project ( British gent)//Kassler finished susy ( gent on RNZ)//////angels wont enjoy their party//the teenagers don’t like Finnegan ( young girl)//priest said need to watch what Vicki does ( British gent)//LB says you are going ( unid female)/LB has been l ying again ( Maori female)//think its Natalie ( poss NK-presenter Al Jazeera)///JEs papers -also anthrax////LB said she wasn’t good enough//comments JE and womens group//NZSIS have something for you/// //NZSIS finished you were frequently seen some-where//the regular interference of Mrs LB///NK said she had to be brain damaged//JB assault charge in Kenya//// reason Kassler made change in Wilson family in JBs file//JE said Vicki didn’t have the intelligence////NZSIS staff member gave Vickis papers to ann simich and Mo Kassler//its been signed above/ photos of /NZSIS officer standing over a couple of bodies///

c
Threatening/derogatory comments: “Start f…king” ( unidentified American male in Amapur Drive Khandallah)// Assassinated in 1950s/1960s ( American woman – ///)///// ///// “Fart /wog” ( a former female neighbour -a lady of Yugoslav extraction and wife of the Irish Secretary of the Electrical workers union in Khandallah/// “ Yid thing/Jew thing”(unidentified young woman) ///// “Its your death..they might kill her off before”…. ( Pat Wilson)//// “Blackmail” ( Pat Wilson) //////“Vicki hasn’t any brains//committed //I have to get rid of Vic///tasked my psychiatrist to break you” ((Marianne aka Maureen Kassler) “Its death dear”( a well groomed woman at Devonport///// “ why crippling” ( Norma Bisheno a former British neighbour twirling her fingers around her ear in a gesture denoting insanity)//// “Boring old f…k” says ( a taped message emanating from our Scottish neighbours in St Heliers namely the Vicars) “you have been wasted” ( young middle eastern man/// a sinister reference of several years ago to “ your fate worse than death”. (a middle eastern male)/// “ Arrest her//nut case” ( An Israeli national and his wife resident in St Heliers)//// Other comments included : ” kill Vicki” ( and island hospital overnight nurse at Auckland Hospital)/// “the sacrifice of Pat Wilson”( a chinese student on an Auckand bus) Getting rid ( Scottish radiographer Auckland Radiology) ) ///“Mossad’s sacrifice of a mental case” ( real estate agent from Ray White)///// “Delphine chose nutty” ( Detective St Heliers police station)// Human rights Ha Ha! ( Mrs Higginson the wife of a local police officer) ////// ( ” you will be killed” ( passersby in Whangarei- one comment from a gentleman in Ruakaka- the other a young woman in a queue at the office of the Ministry of social development ////” you will be shot” – a woman passerby at the Okara shopping centre in Whangarei.////// “ “Committed” ( Dr Van Roekel of St Heliers “Nut case” ( Dr Henderson at the Onerahi practice///// “Nut case” ( Manager ASB Securities)/// “Mo says she hasn’t been told” ( Senior ADHB staff member named Jan and friend of Mrs Christine Hawke)The Kasslers blowtorch the mentally impaired///used them for entertainment/// destroyed a cats passages////Colleeen mutilated a seal pup at red rocks (Wellington///)
“She will have to be assassinated” ( female relation Nurse Christine (Naden) Hawke/////“Delusional about the infection throughout the whole body” ( ENT specialist Dr D Tandon) /// “At bron-choscopy in July 2004 the left lower lobe was normal and no photograph was taken. The right was photographed just to show you how normal the appearance was in general.” ( British Respir-atory Physician Dr Garrett) “ a bad patient and the police as well”( from a British doctor adhb eye clinic ////// “Mrs Simich doesn’t like you attending these classes” ( a tutor at a computer class in Meadowbank)/”///// “Clem says its behavioural problems” ( Cardiologist Dr Ted Clarke commenting to a young male visitor about Mr Clem Simich immediately after my consultation) “Clem says its Vicki” ( female staff member using her phone while seated in the car park subsequent to the same consultation)////Mrs Simich says you will have to….. ( assorted coercive comments at-tributed to Mrs Anne Simich) “Ms Wilson and Miss Horsfall” ( a dapper elderly Japanese gent on the phone outside the BNZ Whangarei Ms Horsfall is a police officer)///// “Why I got rid of nutter” ( middle aged British woman resident near Kokich Road Onerahi)
( “Incarceration into mental institution” described by orthopaedic specialist Dr Tasman Jones as a past practice for dealing with patients they didn’t know what do with apparently including my mother who was afflicted with carpal tunnel syndrome. //// “Nutter” (Dr Roblin at the Onerahi practice) Assorted derogatory comments from some of the inhabitants in my retirement units including “Nut” /psychiatrist getting rid of her”/// ( comment from an aggressive female geriatric neighbour)/// nutters( Retired nurse- neighbour)//// “Begley says its poop” ( Dr Cameron of NDHB ED chatting to a Maori female staff member) ///Assorted comments from Police and surveillance? staff presiding over my Whangarei unit including the bathroom.////// “Nut case” ( com-ments from a Maori and Filipino group at a hostel in Ruakaka///// A former neighbour at 66 West View Crescent (possibly a member of the scientific community) was singularly uncommunicative but was overheard discussing my tenancy on one occasion. Assorted comments from Police staff indulging in illegal satanic remote viewing voyeuristic activities over my Whangarei unit including the lavatory-including “You need to go to the toilet”// from one particular officer///////
“ British say don’t help” overheard from a British man in the background of a phone call to Samsung repairs/// “Whitney had details of a cherubim in briefcase” (American media) “Whitneys were chariot makers in 2AD”-details retained by Elie Saab) ///”Don’t like the expose”///why we conspire /don’t like angels( male police officers )///”/Why we’ve been wicked” ( strident female watching a local laboratory) ( “doesn’t have a pottle ( Maddie McLean- also odd comment from J Wells J Tame also of TVNZ) and /////”Mrs Simich has details of experiments”///”Mrs Simich is preparing Vickis cage” ( local shop assistant) “Mrs Simich is ending Vickis medical “ (unid female) “Melitia investigating Vicki’s tabletting”///”Ms Kasslers advising Melitia”///”Melitia gets zipped up” ( unid females)/// //// “”///Melitia has bios hidden in the bathroom ///////Melitia going to torture poppy (re Melitia 16A Sherwood)////Melitia compiling a profile of Vicki Wilson/////“Mrs Simich might destroy your passages”( well spoken British woman also “Royals don’t like mentals in the family”/ ///Mrs Simich said these are details as to why they ruined /////“Simich told police to increase harassment” (unid female)// Simich is watching effects on the brain////// “a paedophile court case-name suppression” ( unid female)///// “photos -strapped to their seats” (unid female)////
“The Kasslers contact Melitia” ( resident of 16A Sherwood) ( unid female) // “Mobile have details of someone in Leavenworth” ( unid female-presumably a reference to relatives in Mobile Alabama) // “You are on a knock off list” ( young woman)// “Senior specialist had bios in briefcase and details of distribution” /// “Miss Kassler meeting Haumaru”// “Hart” ( regularly repeated by an Australian gent) )// Mrs Simich received evidence from Hart //// got rid of a blind person stole property ///
Why you have been sacrificed ( senior female medic visiting the endoscopy unit Whangarei Hospital /////assorted comments from a voyeuristic male medical group during a colonography procedure at Whangarei Hospital)////Its witchcraft ( Marilyn a whangarei neighbour)///Miss Kasssler doesn’t like mentals in the area ( a Kassler niece) ///something in Zurich //////It’s a British royal lesbian// collects podcasts next door ////medical secretary responsible///// //////Ooh! ( possibly Jan Stokes)/////remember venetian blinds /Australian surveillance opposite ( probable ref to an old Sydney bedsit I rented in Sydney in the 1970s)/////// “she will go to trial” Alan Roberts Unit 9)///Ann Simich trying to prevent medication ////the kasslers blowtorch the mentally impaired///use for entertainment purposes///goosestepping////
Mrs Fruean(Haumaru Pensioner Housing Auckland) says you wont leave// you have been committed/////// “what she did- get the dog”/////Barbara runs “wet affairs” -(assasinations -Nurse Barba-ra Unit 7 Sherwood Road Whangarei) // “Id of the Sorrel family” ( poss ref to the Lanigans -relatives)// ‘Its Vicki’/// (poss Jessica a relative of Melitia )/////Melitias mother goes with young wom-en///// “Melitia has now befriended german container”///// “why we conspire with terrorists” ( poss Police officer)/// “Bruce hired Ashburn” ///discovered leptospirosis //////Robinson cried -what parents did to save their skins ///////Mrs Simich thinks it’s the tree of life in kapok’s possessions //////did Mo Kassler go to Malta//// ////discussing ditsy in courtroom /////arrested Uriels son//////why we are destroying ( poss Rhonda nurse at Bush road medical)////Melitia has details of Vickis whatnots ////this police says its death /////police don’t like it online //////Fruean says you will never go back (Maori gent)/////
Whangarei area full of plutonium //////Melitia getting something from Mary Daysh ////Kasslers don’t like the Blakes being here///////Details of money with New York District attorney/////Melitia has been experimenting with malaria/////neighbours say she will go ( driver of New World van////)Ann Simich is arresting /////Israel f…ks WINZ ////////Kassler says they sacked Uriel /////Vicki considered to be slightly mentally impaired//// The Fenaughtys /////////Instigator was Gehlen ( a nazi war criminal associated with the CIA)///Melitia meeting police up the road////Simich seduces Fruean //////Pretty young woman kept in chains for her entire life///presented as a murdur/suicide //////Its for torturing ( dark haired woman -visitor to unit 8)/////didn’t save Liam///lots of papers to be taken( Melitia 16A Sherwood)///Psychiatrist doesn’t like it being made public ///Mrs Simich says she isn’t sick/////Melitia meets nerve gas///Bruce asked to see sisters revenue///////Karens blood stained sweater///////the frequent visitor to Tanya Lankovsky/////Bensemann said she was a nut case/////sacrificed Vickis bit//////Melitia has been ringing Hunt //////why Kassler is getting a large sum of money////dangerous nut case ( Maori woman visiting Mrs Jenkins 16 Sherwood//////
Mossad discovered why she has been sacrificed///// /////relatives killed in the coliseum and guillotine/////evidence in Simich’s//////Zohrab //////)///start with Grampian way ( Jack Tame or sounda-like)/////ID of Russian psychiatrist /////Mossad think its Malaysia////Melitia getting names from Canberra//// //////Mrs Simich says there is no escape////Mrs Simich says Vicki farts in pub-lic///////Kassler trying to get a ruling////meeting Dr Millers offspring/////Fruean had to get rid of her ( Maori female referring to a senior Female executive at Haumaru pensioner Hous-ing)/////Delphine says there has been no recognition ( Delphine Lomas formerly of St Heliers and occasional resident of Locksley Ave Onerahi)/////Harries didn’t like British psychiatrist/////something in Zurich ////////Mrs Simich said these are details of why they ruined ///collecting podcasts next door/////medical secretary responsible /////Melitia has details of Vickis house ////she gave a desperately ill cat/////german shot space/////Its Melitias cousin ( Jessica)//// ///////yes we conspire with terrorists (poss a police officer)////Bruce hired Ashburn //////discovered leptospirosis//// Mrs Simich has an arrest warrant//didn’t like complaint /////something terrible hidden in Martin Carrolls file( former State Dept official)//// An instigator was a member of the Carroll family/////
Kassler had an address in Bordeaux/////Details of Medlicott (Ashburn Hall) with Sarah Jenkin)//////A map fell out of Alan Wilsons file////Clem Simich has sarin gas/////Melitia instructed so-cial/////Clem Simich sacrificed brain/////Begley reckons its Mark ( poss Thomason) ///////Instigator was a nursing staff relative/// //////doctor met police/////why did relative tell serious lies//////royal princess murdured an angel family//////instigator was Laracy( poss male police officer)////////Melitia watching effect on brain ///////the way Melitia is getting rid of Vicki old////Melitia compiling a profile of Vicki Wilsona////////paranoia ( Melitia 16A Sherwood)///why we don’t treat ( older woman poss nurse or medic)///Melitia said this is Erenstrom (a ref to a former Medlab direc-tor)///////Shipley?no match for the kasslers/////Melitia takes taxis/////Simich going to force ditsty////police had a complaint ( male police officer?)//murdur most terrible ( British man)/////US made a terrible investigation //////might be something in Riggs (Riggs Bank Washington DC)/////something in Goldman ( Goldman Sachs)//quiet comments poss Minister A Little
///pictures of fairies with fatso (ref to militia)///////hidden behind woodcraft is a formula/////////bags hidden under Latham street napier////blocked off ( Latham St former home of the Kassler family)/// its vicious Krtschil( German container depot Sydney)//////Jessica said you once had a catheter ( ref to hysterectomy surgery 1988)//Mrs Simich says you will go ( female shop assistant middle east?at the Onerahi dairy)////Kissinger sank you ( female owner of 2nd hand store Onerahi)///////Princess Margarets insistence ( female British)/Why Vicki needs a taxidermist/////why its being imposed ( female)//your wicked nonsense ( older woman low voice)/////Why high psychiatrist came////////Its Medellin/////Descendent of a princess?found dead in Aegean/////Tony Blake runs scrap metal-mixed with 2 parts caesium////////Ann Simich says bizzie will lose everything /////discovered an old cold case///FSB said something to Bruce about sister////discovered in Vickis blood tests//// Its Vickis death ( Barbara unit 7 Onerahi-barbara runs “wet affairs” )//////Lost table/Moselen sacrificed it ( ref to a recently sold table to the Moselen family) why did the police visit Moslene////-Alan Roberts unit 9///Ann Simich inspected damask (chairs)//why Simich asked to see Moselene///// why did the police visit Moselene///)///long list of little girls////Simich said she is not sane ( Marilyn unit 5)////tied ropes to cat Eliza and pulled the cat apart/////Melitia’s psychiatrist asked for a ruling//reason for serious venom ( unid female)/////watching Melitia taking up Vickis operations///photos of Vicki standing at the cenotaph////the Mitfords ( female British)////harassment from Moseley
/////Details in Mrs Simich’s file why so many NZers have cancer////investigation discovered hidden cancer in sputum////Hart ( Australian gent)////Ann Simich interfered with Mirela (Haumaru Housing)////The Jenkins are spetznaz///did switches///////Mrs Simich says you wont go ( male police officer)////police visited a manager//////Clem Simich meets bus drivers///Vicki has to be assassinat-ed ( Chinese bus driver smoking a cigarette Takapuna)///something hidden by Giesen ( Dr Giesen former senior gynaecologist Wellington Hospital)/////////descended from Auschwitz//////there is cancer in the blood///Bruce provided evidence of mental behaviour////////Clem Simich says its murderous Psychosis/////
/what Mrs Simich did ( Robin unit 8 36 Taharato Road)/////have to get rid ( uni maori female)….should have got rid ( poss Ann Simich)//// Its me ( gent aged 60s dark brown hair with drooping moustache -poss relative of Clem Simich-Bus to Tipunga)/////Mrs Simich destroyed Madeleine ( pos ref to Madeleine Pierpoint)//////British psychiatrist is going to rip off (unid male )///police visited a manager////Hart ( Australian gent)////not yet coughing up blood (unid young man////Mo going to have a sex change( und female)////Simich said its terrible destruction/////watching something on Ebay////Carol chose this old one///police sacrificed wandering advice of doctor////this psychiatrist said you wont get this one -unid female/////Miss Kassler bought a place in Banksia Beach///something in Bruce Wilson’s history////mad has killed his family/////Megans mother was a fraudster////////Not sick ( young man)/////threw in agony over the edge/////Bruce has got prints///
Continuous order in SG car/Al Qaeda high command////Clem Simich says its schizo ( police?officer////put a nana angel into a cage/////Vicki Wilson will be red-eyed at rejection (Indian female at a local bus stop whangarei)Al Qaeda destroyed a fairy princess//////something hidden in Barlows case////Mrs Simich uses mental cases for sex//////Melitia gives the kid poisoned lollies//////Melitias kid has been given bromide-receives pin pricks/////neighbour has details o f Vickis correspondence/////discovered Harry is a trained neo-nazi////Hart and Khalie/////psychiatrist crushed a brave girl/////someone keeps visting MSD////Clem Simich sacrificed you ( Maori female)//Alan descended from Lafitte////Melitias psychiatrist destroyed the monkeys/////Interpol discovered rights of car-riage///Cowan//////FBI hiding something////repeat meningitis instructions from staff////discovered it’s a Director of a Fashion House////discovered stomachs had burst open//////police didn’t like details of the Whitney family////Auchincloss/////murderous brain////////Simich is the purveyor of vicious destruction////Clem Simich says get out of here( Nurse Barbara Sowerby 18 Sherwood Rd Onerahi)Ann Simich is destroying all pets////Harassment from the Bush family
////yes police protecting Melitia/////Melitia investigating Vickis investment-demanded Vickis mental health report////police asked about something in colonography/////blew up Israeli////cousin doesn’t like wiretaps////Mr Dacre says Miss Kassler is masterful/////Clem Simichs psychiatrist is visiting////Simich sits by Jeanette////this bag is full of false teeth////// pus levels hidden in Simichs//info from Geiringer//////Dacre said its not his sort of case///return of a ghost family///Ann Simich said both children descended from mental cases///psychiatrist taken nut( Barbara 18 Sherwood On-erahi)//Miss Wilson will be leaving with someone ( husband of Melitia)//discovered who was fixated////Nurse Barbara runs “wet affairs”////Ann Simich has bios in a glass case////conspiring with a murdurer up the road////she is not sick ( young man)Al Qaeda taken Los Angeles////Clem Simichs file -bastard from the Astor family//// ////Miss Kassler has tongs/////( Fartys computer////Gaby might uplift computer ////Farts in the school ( Graeme unit 5 Taharoto Rd Takapune) Mrs Simich says you will go////Israel had a list of experimental children in the 60s//////details of Melitia at the border////Melitia bought it on the internet hasn’t paid for it///Police don’t like details on line////Mrs Simich met Mr Corless//////pimps ( British gent)////Israel///psychiatrist say you will go////Miss Kassler uses poxy resin on felines////Kassler had details of nazi ring in Wellington///terrible hidden in ipad/////vicki lost freedom///priest discovered they were beholden to the Kasslers///
He complained to Gaby ( prob ref to neighbour in unit 5 36 Taharoto Rd)///Simich thinks Vicki should be committed////paranoia//madness ( Indian female dairy owner /near Waitemata Hospi-tal)////Arrested Alan Wilson////Mossad thinks its Mount Crawford////Its Ashburn ( Ashburn Hall -psychiatric institution Dunedin)////hasn’t seen it yet////go to Palmerston North ( Graeme unit 5)/////discovered stuff in Nazi high command////evidence of Indian psychiatrist///kassler niece///medical bombshell///discovered a car////insanity has taken its toll ( Maori female////the Descartes family///police had a ring with a picture of a crucifix on it/////police have received a significant complaint ( police officer)///Mrs Simich doesn’t like intelligent ladies///Hart ( often repeated-Australian gent)////Ann Simich assassinated the real Bruce Wilson////you don’t realise what has been done////these units should all be sealed////Mossad British decided to get rid/////doesn’t explain why medical profession tried to get rid of her( British gent)///)////
Hart has severed-NZSIS gave carte blanche///// Dacre met Jack Price///British psychiatrist waited////packages of headless bodies///British destroyed the cats spine///Gaby says you will go ( Maori female)why you will be killed( young British gent)///medical group-doctor knows why////this place has been scuppered///police definitely trying to prevent investigation////police will have to do that ( young woman)///you are depraved ( Robyn unit 8 36 Taharoto Road)///spy doctor says she has to go///Melitias enquiries have reached Fernandez in Canberra///why did Vicki fart go with the police ( Graeme unit 5)////Evidence at Japan ///why you will go ( elderly European woman neighbour in Taharoto units)////a severed leg/// Hart -yes he does ( British gent)////
Details of savagery in Bruce Wilsons////details held by Pat Macintosh(-former st marys old girl)////Miss Kassler ate a sparrow////your effects have been destroyed ( British gent)///why Waitemata trying to get rid of her////police said they have strange photos of alan Wilson/////Melitia gave it to Mopsy/////Details of money in William St ( poss a ref to Hamburg Sud William St Sydney)////Mrs Parshenko goes with uncle Jack///////Jack Fruean was once remanded////discovered something terrible in Simichs-a young girl in the 70s//////Melitias parent has your HIN///////it’s a repeat draconi-an( unid female)/ recommitted ( covid 19 press conference PM J Ardern )//////Alan descended from Solomons family////////they killed the babies -don’t harm her any more//////you were a princess of Latvia////little Kassler let something slip/////why they had to lie/////Black Dahlia-Miss Short on a list of descendents?///////Melitias child had pin pricks all over her back/////Melitia discovered stor-age/////metropolitan police here///poppys dead (ref to Militias cat )////
Mo Kassler frequently seen at Orly airport////discovered tapes of Melitia making nasty comments to her daughter///Melitia had to get rid of little girl////psychiatrist has Melitias complaint/////Medical disclipinary is here////why you have been got rid of (Maori female///why Ms Fruen sacrificed frump/////arrested someone in admin////Miss Kassler won’t allow you to get away////Simich says she cant stay////police investigating the case of Daly-Peoples////it’s a vengeance family////Simich hit Livy/////the judge is here-something bad in family history////Bone says its everything -psychiatrist can take (British female)////Mrs Simich discussing something in Vickis background////British sacrificed a pretty angel//////why did Simich choose Susy/////something odious made a terrible decision////Melitia has details of missiles////Kahlin Cook fouled up an airline schedule-fled away//////Kassler kicking the cat around////Christine Harnett an entrepreneur////Kasslers related to Judas Iscariot////why a British mother has been sacrificed///Bruce thinks sister has a history of mismanagement///why you will be got rid of///
/Its fairs death ( middle eastern gent)////Craig Thompsons father hated the bastard///Clem Simichs insistence ( Australian gent)///Israel finished poppy/////Its spy monkey ( Jacinda Ardern -covid televised address)////Al Quaeda poked a little girls eyes out////Why does Vicki dress this way ( young man milford mall ( remote viewing) also a comment from a well spoken gent)///this is James Hogg////something nasty about the staff there///Vicki has to destroy cat ( middle eastern young man)///Mrs Simich gave something to QC Dacre/////sacrificed bi-polar (-poss ref to daughter of Jessica the cousin of Melitia -Whangarei)//// its your freedom( poss ref to old ANZ account)///Bruce has a property near Warkworth///Kassler set up/////Miss Kassler has a requirement for Vickis torso////Miss Kassler has an arrest warrant for you///Kassler niece describing how they destroyed Melitias cat////This is San Quentin ////////Its Lomas////Tomorrow ( J Kassler in a passing sedan )////this psychiatrist ( gent softly spoken//////its happening ( Maori or Island female)///owner of a puppy is a sadist///FSB have details of angels accounts/////this is the police/////Gaby met the police (Gaby Clezy CEO Haumaru)///FSB had photos of docs//////
this is Maori mental health////this is Kassler discussing burglaries/////Gaby says you will have to leave-you were taken away by the police////you missed out on a life of luxury ( British gent)//something hidden in Merch///Medics used ladies from the line////British psychiatrist thinks you might need to leave the district ( British woman) Mental case ( Dr De Beer Waitemata DHB)//This doctor doesn’t like angels ( poss Dr E De Beer Waitemata DHB)//////// Dr Etienne said this my answer (British gent)// what you have been subjected to///this priest ended independ-ence/////Mossad discovered what they used on the family////committing ( poss medical gent or psychiatrist)///////Miss Brown in Ministry-sacked -propositioning men/////Mossad discovered its dipthe-ria/////Barbara//hid a shadow (prob ref to radiographer ADHB)//why continuous meningitis ( quietly spoken gent)////you might need to meet psychiatrist (female)///Mrs Simich you will have to (young woman)///Police sacrificed Vic Wilson///the interference of your lawyer////why police sacrificed ( young male police officer)////Bertie ( female -ref to male tenant units whangarei) ///Melitia spreads stories // The international court//////Simich began with the dangerous fairies family/////Miss Kassler tried to shoot at angels car////Dacre messed up///there is no cancer //
Melitia dumped her on the street////Mrs Schisca/ orYska/////discovered something over there ( British female)///why it’s a seriously bad case/////A contact of Moxham/////Assorted comments police officers/////Details of Russian in San Quentin////Mossad met Simon Cowell////details of Russian princess/////taking money from Potsdam////Simich says you are going////sacrificed vicki ( tall slim blond woman accompanied by husband ED dept Waitematia DHB)//sacrificed bulldog////sacrificed dog Trudy////she might get upset about it////why Bruce wouldn’t help out////Miss Kassler defraud-ed Correze’s estate/dug a large trench//////police sacrificed Wilson ( male police officer?)///I will fix that ( Kassler niece)///relieved themselves ( police officer -bathroom (rv) //police didn’t accept Vickis explanation///Vickis history////the id of the Coster family////member of family once charged with assault and battery//don’t believe you are a feminist ( young man)///not an experimental case ( well spoken gent)///psychiatrist said we have learned the odious truth////police don’t like you going there as per instructions from the Simichs ( male police officer?)
Karen hid a secret ///photos evidence of Australian psychiatrist///Melitia destroyed bladder////Simich thinks cat Sewell is dead////why an Auckland psychiatrist began to lie////ditsy used to kickups /////Al Qaeda discussing the id of Christs children/////Mrs Simich says you will go/////started cruel ( british woman)///Vickis sacrifice saddened the old fellow////didn’t you realise lawyers are witch-es///////this is Percival///doesn’t like shaving ( young woman)//Mrs Angels death////the priest finished bananas ( Italian? gent)// Bruce has luxury condo//ponzi schemes/////the former assistant of Mike Bungay/////something hidden in Kasslers London////a relative stole the money///Its Richard//// has a list of young women////real mother is Mrs Longine///Fortis used to visit Alexei///////seen visting flea markets in later years////////Fortis family////// Belgravia////kid’s id in a box///mother has been slit ( middle eastern gent)/////baby very disturbed at the death of mother////cop told lies///why the commissioner////discovered a list of strange murders/////Mossad visits Hart/////go yoghurt/-your sh..t- Its MA ( tall gent supermarket wearing a padded jacket with wife and baby -poss police ?)///
/Israel think they are hiding something///British psychiatrist keeps trying to get rid of it//////M Kassler rings the Queen -private number////Mrs Simich says this is on the basis of a sputum test/////Vicki going to hospital ( British woman)///machinations of vicious Dunlop////Sewell kid is missing//////Jan Blake appeared before medical disciplinary/////confession from high Mafia/////your morphine///////something hidden in little girl/////something cruel needs to be administered professionally ( British woman///Simich decided to force torturing ( young woman)///you will go to live with Kassler /Newland/( British woman)////Doesn’t have enough tablets ( f low voice- why this woman contacted the police ( male police officer)///why the police keep the pressure on///This is Landon Lane////Kassler selected a blind lady////think Kasssler is preparing another bio/////like to see your reference ( poss police officer)////This is the Minister of Justice ( Andrew Little)///police discovered a private detective////Simich shafted poppy ( Melitias cat?/////// didn’t realise details of black psych ops ( older man)///Melitias has collected Vickis at market ( poss ref to former share de-tails)////breakthrough in this case///Mo Kasslers psychiatrist came////Israeli thinks something has been done////Mrs Simich wants the lights off////Dacre said its out of my hands////// Alan didn’t like being revealed he was sleeping with secretary//////Megan is here//// need for a psychiatrist here ( British gent-Milford Centre)///Bloomfield got rid of it/////Mrs Simich says you have been arrested by police (Maori female)//why Dacre dropped the case/////police discovered a terrible swindle//// Clem Simich stole vickis boxes/////you will need to go to a mental hospital-well spoken woman)////Its Peter Doone( British gent)///machinations of Martin Carroll////////Its storage ( female supermarket aged 40s platinum hair ponytail////everybody has to get out -discovered silver ( British gent)/////Mrs Simich thinks Virginia has a nice figure/////selected an insane girl//////
Riyadh running the show////Bruce and Mary have sold NZ property///Miss Kassler notorious-once taken by London police////Mrs Simich lambasted Dr De Beer/////Melitia inflicted diptheria////why Bruce came (Maor female////Mrs Simich thinks it’s a picture//////Kernadine//////Mossad has details of Vickis painting////Israel say Vicki is finished////police visited Virginias parties////discovered something in old British neighbours-lists of children?///////the real ids of pat and Alan Wilson////Trudy is the next sacrifice////angelic pilot lost his arm///Mrs Simich chose PM///crazy mad fighting back ( British female)////Its Tamara////discovered what has been done////Mrs Simich sacrificed Vickis independence///British sacrificed lunatic ( young man)//evidence of directive re invest-ment//////Kassler assassinated construction///British killed an igloo family////Karen complained to police////ditsy chosen for torturing ( Mo Kassler?)///agitation of Graeme and Karen Sewell///ditsys shocking nonsense ( female- Dental insurance 34A Taharoto Road/////ditsy has to go then ( young woman)//where you will go ( British gent)//Dacre wont represent revolting ( well spoken gent)///Labplus? something hidden in the blood – strange silvery base//////Mossad said why she cant survive ( British gent)////Simich thinks Vicki is going////Israeli discovered what happened to the images////Mo Kassler said you will have to give cat/////Ann Simich watching thermography///instigator from khalis family///relative from Columbus line/////
Ann Simich has evidence////Ann Simich has been wearing a blond wig////ids of prince alberts sisters/////Morgan said the kasslers were sneaking around up the road //////NZSIS had a list of Alans sexual relationships////princess of Westphalia/////this info means Vicki might breakdown/////Graeme Sewell on a meet with Al Qaeda?//////photos of a man cutting young girls/////Mrs Simich meets sequoia ///Did alan used to meet Tanya Lankovsky/////Mossad said its Lou/////she lies around all day with the cat ( British woman)///It’s a disposal////Its Bob Thompson///Its Thornes/////Simich said she must sacrifice devoted////comments Dr Thorpe/////why they arrested Alan Wilson////nasty thing has been handed o n/////It’s the Queen ( British female)/////British chose you ( Female British psychiatrist?)//comments Kassler nieces and young women-know how stole the money/////Kasslers have a sex dog/////details about an ignorant bastard///Bruce thinks his sister has large debts////Simich thinks they assassinated a staff member//// Its Bob Thompson Miss Kassler going to destroy Vickis passages////police say she has to say goodbye to beloved ( young police of-ficer)///Miss Kassler said Vickis not affected////A murder most terrible////police confiscated photos at Miss Kasslers///Kasser f.. ks beehive/////Mrs Simich…a special project////ironbridge ////Its Bridgman ( former principal of St Marys Wgtn 60s Sr Matthew aka Bridgman)// /// what has been imposed on Vicki Wilson (British gent)/////its stigmatized/////Simich issued a court order/////Hart insists on it////revolting NZSIS contacted Sewell///Liar///revolting ( young man -police/surveillance?)/// police commissioner is Cosa Nostra///////police might meet Vicki Wilson/Mrs Simich////doesn’t have..excrement ( male police officer-bathroom)////the commissioner is descended from Caligula////descended from the Pharisees/////Wilsons were terrible men////screams in Melitias place/////kasslers have pictures of internal bleeding////Melitia experimented on shaved areas of cats-pockets///////Melitias cat found dead over the road////discovery in Lapland////discovered Vickis orphanage////TVNZ doesn’t like (rosary) beads ( Miriama Kamo)/////Kassler sent emails to GPs/////Milford Mall: odd comments police officers///////Simich says she has bugs she cant get rid of/////Russians remember when mater ? was pregnant////what has been quietly done///Michael Begley destroyed the family///police discovered a cold case////US president is aghast/////neighbours now have Vickis weight and height//////why Bruce and Mary hid away/////Ann Simich met Audrey ( GP Dr A Thorpe )////////container insisted on placement of a nice person////It’s a parental sex case( RNZ)/////Police think Alan W practiced theft///////started destroying Haiawathas family////Trofimov contacted Neary////////Kassler niece used Melitias pet for a frenzy experiment///its rough Spanish/////what happened in 1973/////discovered Mrs Simich accompanied Bruce on a flight////Hart ( Krtschil?) visits Simich/////it’s the id of “purulent” ( ref to Dr M Cornere)/////police going to take all this away///Bruce thinks you need to pack up////
somebody in the Kassler family took a lot of money to sacrifice the family///details of big earthquake in the Andromeda case/////Longchamps///// police think you should leave quickly/why the police sacrificed you ( male police officer?)///you are going to court///wont treat murderous nut cases///law professor thinks you have a case///police force! ( police officer older man)////details about Nicholas and Alexandra//////Miss Kassler uses a pneumatic////she is being destabilised///Clem Simich crashed a mental case///its your terrible mind////discovered why they lied////why beads was sacrificed by experts////specialist visits Simich/////the police said she throws everything into the wash ( young woman)//Simich said there won’t be another $500,000//////why you were denied that info////Mossad think bizzies finished there( police officer?)//complainant is Mansfields staff//what is happening ( Kassler niece)///Ann Simich got rid of the cat////got rid of vicious Begley /lying to the police///Vickis cat might be very sad (British gent)//this is reception ( prob female staff North Harbour Medical )/////Kassler spreads strychnine////Megan (Cornere) didn’t see the report of 2011////something with the police minister///you might need to see Brant next time///why psychiatrist has to get rid of Vicki Wilson//somebody wanted the unit////British psychiatrist said it’s a lunatic////she will have to be tortured ( quietly spoken gent -poss Australian?)//////this occurred because your staff told lies/////Ann Simich taken Breeze ( bulldog formerly of the Beach family)///now sacrificing families ( young woman)///Ann Simich said why its genocide///Mrs Simich sacrificed pet Beach ( female RNZ)///// Dr Cornere received a massive amount of stuff///Russian plastic hassling Audrey////discovery in the Greys////Mrs Shipley has a painful restriction///Melitia decided to prostitute the little girl/////loss of fortune with Eichmanns family///Melitias dog found near the air-port///Bruce thinks sister was given bromide////an Israeli has been sacrificed///
It is 50 million////psychiatrists eugenics///eugenics Taupo/////psychiatrist took Ollie ( Melitias cat)////Jenkins shot in the leg //runs burglaries////Simich said a sick patient is getting short shrift( British gent)//relatives didn’t like the evidence of Bruces ownership///Mrs Simich destroyed your rental///Hart ( Australian gent)////Kassler has an hysterical pet///police don’t like the complaint ( young police officer)//Clem Simich didn’t like you coming back here///detail of embarrassment with Mossad///Mrs simichs psychiatrist went throught all Vickis books//Its Ann street///videos of a Simich party/odious discussions///Kasslers began ringing medical receptionists////Alan forced into unusual sex///mental case ( well spoken young man)///why NZ has been selected////GP doesn’t like aeruginosa///Mrs Simich contacted psychiatrist//Melitia discovered something in Mossads file////little girl Wilson is Bunny Wingfields child////skid row discovered Jack Kennedy///living oddly is going(Melissa Stokes)////Clem Simichs psychiatrist has authority///Melitia uses tweezers////you have been ruined ( Maori female)///you are a gonner ( female Maori)//Marilyn said ditys sacrifice is complete///Killed the real Pat///this is Golden Circle (Australian gent)///Simich says you are going( male police officer)///police punished vicki Wilson ///terrible phone call from delicatessen//why did Etienne say that ( Dr E De Beer)///Melitia practices strangulations///Dacre meetingMary////This is Mrs Craig Thompson///
UA in a panic///selected dog got frightened///Denise discovered a nasty case over there////the sex ofAlan of ( British gent)///Israeli said Vicki will go///police don’t like hits in the area ( police officer)///can see Bruces grief////Dacre takes advice from Mrs Cassel? /kassler? behind closed doors//////ditsys tenancy cancelled ( TVNZ reporter)//killed a mermaid //this is high Australia ( unid female)//medical putting a lot of pressure on nut cast ( poss J Ardern)///nasty business ( male security officer at North Shore hospital)///Bruces weird fixation with family///police had a list of infections you were afflicted with///police have Wetzells bios///there are witches in the area///Kassler forced Mrs Fairys assassination///Kasslers are ringing the Mengele family ///////Melitias cat hysterical///Slabov (FSB officer stationed in Wellington in the 60s ( a name in J Kasslers file////this pet is in crisis///you will need to join shocking atrocities ( British woman)///Huge amount of money out of North Carolina//
//think you will be in terrible agony///Alan started visiting low level brothels////Kassler drove around the farm///neighbour discussing the way they hid the cancer/////something terrible in Simichs program///hidden by the mother of Lance ( ref to Mrs Karl Hintz -a contemporary of Pat and Mo Kassler in Napier///Ann Simich chose Pam Anderton./////////Simich said police need to see what she does///instruction of Miss Kassler//Melitia has details of Vickis stock losses///you are going to be beaten( British gent)//frater going to put you away //Sam Giancana////Israeli says its entrap-ment///Israeli waiting until clot is dead//its why you will be assassinated//Mossad discovered there are missing frames///Simich cited bad Wilson////Mopsy ( Female friend of the Jenkins family of whangarei)//Melitia tried to throw the cat in the river///Bruce involved in Israeli business//gone bust//Mo Kassler visited Ashburn Hall//Bob Thompson used to follow//it is the wicked old Beaumont family///discovered hot koalas -al qaeda irradiated forests/////John Sopel investigated Alan Wilsons DC shenanigans////weird kid wrote strange things about old ladies-relative of Penny//// Bob Thompson used to follow//it is the wicked old Beaumont family///it is something hefty said////Natchbull harassment////Mrs Simich said those things are with us///discovered who murdured the family///Mrs Simich told the angel to come with us please///CT thinks Vicki has fractured vertebrae and coccyx//psychistrist said its widdles need to watch what she does ( tall gent Jewish?in supermarket)///Miss Carrrig has details about this case///False! ( American gent in supermarket)///Its Jacky////Osiris led by the Kasslers into a maze/////something terrible released around the Wilson family home/// angel being held somewhere///Ann’s cat crying goes to the neighbours///Mrs angel terribly mutilated////police found something strange in Al Jazeera///Melitias child hiding in the shed///somebody discovered the angels getting secret messages///Dale Bramley didn’t likeDr Puttick /////Mo Kassler has toilet rolls scattered around the room//why there are deadly repercus-sions//Simich murdured a family member////Melitia gave the child Epsom salts///
/why there is serious witchcraft ( Maori female)//discovered a crying horse///Bruce said Elegance magazines with Maureen///Its vicious cathedral/// Boyce//might need to look in your eye///reason why parent lied////Vickis fate ( C Hipkins)///Miss Kassler listens to pipe bands///bombshell////what will happen with susy///where you will go ( young girl)//make sure you don’t get a chance ( Ameri-can female?-low voice)///Mrs Simich sacrificed roses////FBI discovered something in prison///Israelis say it’s the Waitemata chief///Blakes place had to be sealed///Kassler using it as a broth-el/////this psychiatrist sacrificed Vicki//Bruce told to get all her things together///cancer is deepening ( young woman)//Alan didn’t like the police questioning is secretary/////Mo Kassler caught up in a police raid of a London flat///Mahogany table in Moselens basement advice from Ann Simich///Simich severed the relationship with previous GP////Bruce thinks his sister is going to wok///where the psychiatrist will put Wilson ( poss Hipkins)//did psychiatrist get rid of her ( A Bloomfield Chief Medical officer of health)///Simich thinks its your program///Mossad think its Wingfield///ID of British psychiatrist//Sharon says she shouldn’t have those//Simich said she shouldn’t be told/// A directive ///priest tells lies ///why you weren’t told that (British gent)//details of destruction in Oriental Bay///Mrs Simich has details from Ma Bell(telephone company) ///////
Aggie (young woman)//Mossad discovered why she is being knocked off///need to assess Melitias genocide///this speciaslist said why you are being knocked off//Begley thinks its Vicki//Hart ( unid male )//this visitor is St francis//you are going to died///can see blood spurting////what a NZ psychiatrist has done///Simich knows what she wants//cousin didn’t like Virginia coming back////both psychiatrists said why there wont be any more money////Simich met Bruce this morning////investigating an account in Norway///Hart ( Australian -often repeated)//Clem Simichs insistence ( Maori female)//Megan waiting to see impact of allegation////Kassler spent until midnight with Virginia///fairys been shot///Israel think its Murphy///Bruce Said she goes///Mrs Simich said Miss Kassler will have to keep her eyes shut-need to remove her arm ( Australian? interviewed on RNZ)///Megan chose Kassler///gave Miss Kassler permission to take over your affairs///think its Mary Burt///FSB tried to silence Bruce?///CIA zipped up -you don’t know//why arrest //Mrs Simich might get a new cat ( H Barry and J Wells Seven Sharp)///Miss Kassler visited a section/house nearby?-bodies buried there-clothes burned-accounts?//////////Pat sometimes seen at an orphanage////something hidden in Wallis///case investigated by Anderson////Its Auschwitz //police discovered Alan had a bag of money///Mo Kassler got down on your skip//why US watch Vicki///////British watch over simichs takeover of her marmaduke////this is Sheehan////Simich chose Kasslers//broke in at lawyers// Ben Shipley might have a terrible breakdown//why lost his wife///Melitia went to the ball danced with Krtschil///there has been blatant misuse of public monies//police sacrificed Meltia///Cullen said why she hasn’t been told///Mossad discovered (property sale?)Narrow Neck////Kassler niece watching the laundry//Simich got rid of Vicki//this doctor is getting rid of farting( well spoken gent)///Bergin received additional info////Hart had been stealing///Ann simich has details of jury///NZ heading into anarchy///iniquity hidden in farmland///////Simich waiting on evidence of someone at the ball///why did the media lock away///Margaret Wilsher told lies////discovered pat had money in overseas account///Kassler making sure Dacre doesn’t get a grip///Miss Kassler started harassment of Sunset practice///we have been told to force breakdown( Kassler niece)///fairys faecal ( middle eastern gent)///why the angels died in program//left behind lassie//angel runs a gulf stream////Mary to assess you Mary says she has to go////Graeme Sewell seen carrying wife-driver Al Qaeda-Karen found at the bottom of the cliff///disovered about the practice///police discovered you were sacri-ficed by Margaret Wilsher///Israelis visit Hart Krtschil( Australian gent)//Mrs Krtschil said its cruel///Images said why deliberate( Maori female)//Melitia tried to force a terrible travesty( Maori female)///
Mrs angel has been locked in////something terrible why media sacrificed-details of parent terrible///Mossad said Anderson did it//discovered Vigor Brown Street-susan kassler sacrificed the fami-ly/////kassler used to service clients//Mrs Simich said psychiatrist hasn’t been told///Simich tried to sacrifice both hospitals///Ann simich investigating Vickis rentals//Megan has to get rid of her ( RNZ)///discovered Megan had been in custody///Vicki must end kitty///did you attempt to get an appointment( British gent)///Simich discovered an angel at Maidenhead////Mrs Simich meets FSB/////young Israeli man died in agony////descended from Isaiah///Simich thinks they destroyed hospital////Teddy ( young woman -ref to a small pug dog I met at the bus stop)////objection of Dr Sood ( respiratory physician Waitemata dhb)////Simich says she will have to go///why this angel didn’t live( unid female)///medical specialise in assassinations//// Mrs Simich says she’s not sick ( young man)////fair breathless has been committed ( Chris Hipkins)//why didn’t Hipkins keep his silence///we were told that Vicki baby was a nut case////police commissioner making strange com-ments///this psychiatrist is committing Vicki (female low voice)///Simich getting rid of Wilson///Megan said she did see me privately///Bruce ( Satan)/////because there were charges//Doone queried ditsy’s? intelligence///susy’s place is up for grabs ( Kasssler niece///senior specialist is a shocking liar///Mrs Simich might take you ( kassler niece)//Ooh! ( American female )////Simich finished Vickikins///Israeli girl cant survive( young woman)//your objection dropped out of sight//mental Kassler sacrificed///
Frater stared at tampons//Simich said why she wasn’t told///know why parents lied/members of experimental unit///these photos show why Vicki is so gross ( female presenter CNN)//put the parent of a fair woman into a dungeon///Vicki mustn’t get assistance( Kassler niece)//Dacre discovered why the assassination///Israel bombed up///photos of a tortured female///what in parents back-ground/you in experimental program////nothing wrong with x ray( unid female)//wont get any antibiotics///Elizabeth got rid of family/// schizo? comment Phil Goff and Kassler niece////photos of fart Vicki naked///she expresses herself ( Kassler niece also JE)///Kasslers have details of terrible killing of family members///remnants of Kassler family in 2 bins///your lawyer///Mater once put baby on footpath///terrible screams from the Kassler household pneumatic drill////Mrs Simich has been naughty///discovered a horse with a breakdown///something bad happened here (middle eastern gent/////Miss kassler ate a koruru////false complaint from a medical practice///Its bot ( police officer////strange mist ( maori gent)//its horrible Ann Simich///Clem Simich met Breeze Beach/////what will destroy the bread basket ( well spoken young man)//psychiatrist picked up something///Hart ( well spoken British accomp by Kassler niece (-bathroom)///
found dead Lucy///took advice from Percival//stella McCartney and Paul might be relatives///Melitia mutilated a cow///Ann Simich discovered an account in Sydney///Bruce ripped off Alan///Bruce rang Gaby Clezty///Mr Dacre wont assist revolting ( well spoken gent///Mossad says its Hunt///Nancy Trengrove (deceased) had details of hermetically sealed////Chris said she was used as a carri-er///Kassler met Wright///ditsy mightn’t get much older ( Asian male -Shore City)//Ann Simich says you are corrupt///your lies caused a serious debacle for your daughter////there has been a com-plaint to Googles management//Google giving info to police///Israel discovered why she is being attacked//Israeli once put an angelic child into the rubbish bag///Mrs Simich goes with doc-tors////the Agency tried to get rid of family///Israeli discovered hiring teleprinters///why you are going ( young women including Kassler niece)//discovered criminal covid contamina-tion//Jacqueline? sacrificed an Inuit family///you will go with Miss Kassler ( Kassler niece////comments John Tamahere and David Seymour//shot senior Israeli///Sim seen with FSB////Ann Simich broke a small animal//regular comments from a well spoken British group///they have sacrificed someone up the road//
Grinlinton ..advice of British psychiatrist///Miss Kassler said Vicki is going to have terrible suffering///Mrs Simich asked police to watch what she does///angels situation is a gonner/// women getting deadly drinks details with the Germans details hidden with the barman/// ///Miss Kassler sandpapered a bulldog///discovered why a Hollywood family///Dacre explaining terms of engage-ment to Miss Kassler///will have to go over the bridge//police discovered something about Vickis birth///this GP might bury you//Mossad said what has been done//Horrible truth in Karori///the situation is skewered ( Maori gent)//discovered Simichs charnel house//// Gestapo in the background of the case///putting sick cases at the bottom of the pile//Simich spreading terrible lies about Vicki//Simich says Vicki Wilson goes////uncovered lumps of nuclear waste///Kassler forces heartbreak//investigating menacing Kasslers///Simich martyred John///Lies from JFK Jnr////This visitor is Cavanagh///frater tried to burn the papers//discovered the wickedness of Fenaughty///discovered the Len Demler// case////
Jan Blake was sexually disturbed///Peter says you need to get out ( Australian gent)///Ann Simich has a photo of Vickis Regis// why you have to get rid of puss///why we sacrifice women ( well spoken gent)// you are like your mother ( Russian gent?)//something in your mothers background///bite the hand that feeds you ( Russian female)///we will watch this happening( Kassler niece)//Kasssler bashed up a Ministers offspring///something nasty happened in your old place///Ann Simich has details of something presented to Alan Wilson////Asian nana met Ashburn-didn’t like being positioned opposite nut case (tenant Mrs Choi)////Bruce discovered something in New York/// Mr Webster is aghast///Dr De Beer has seen something////discovered the Wilson trust///police discovered medical crookedness////investigation of Melitia ///death in Kerikeri////Melitia has details of secret accounts///you wont go to Perth( female -poss psychiatrist RV) when I visited Browns Bay-poss accompanied by G Reid)////comment Phil Goff (Mayor)/Phil says you are going///report of a meeting in St Marys////she will leave behind a destroyed cat///comments young women and group of men poss police or surveillance staff ( bathroom)///Simch said why this case cant go on////pet of a pilot is shrieking////medical finished off this case( British gent)//somebody has a cup-board full of poisons///
Don’t like vicious mental case/( Maori female)/////Mo Kassler classified as a raging nympho in the UK////related to Caiphas////Hunt is an assassin///This knife kills (Russian gent)// what this medic will impose///why this country is turning into a slaughter house( American gent)///Miss bizzie being sent to death///FBI have a match-arrived NZ 1968 name change?.///////murderous conspiracy in the relatives///Ann Simich attacked Lassie///Simichs have details of t he angelic line//attacked mr angel on a boat///Its Bibi- married a spaniard/////Mrs Simich going to break into Vickis//Paul destroyed a lawyers brief//// Mrs Simich has dog Barnaby/why Bruce has to be summoned///Machinations of Hart (either Krtschil or Schwartz ( Australian gent)////this relation says why you will go ( a Kassler niece)//cousin going to use you as a football///Ann Simich placed the money in Perth/////woman sold into slavery -Michael Begley has the details////something interesting in birds brains ( British gent)///Krtschil retains details about dead women///Kassler is running Carrington staff///this place will have to be handed over to Mrs Simich ( well spoken woman)//why you have been assassinated ( woman Countdown supermarket///Simich said we might be able to scrape it away//Mossad discovered these tests are up the booeye//British brother insisted on it/Money//( British woman)///Bruce met Haumaru how much is rent///its an experimental knockoff///Its go Ashley///Australian says you are kaput///in the back of Ann Simichs cupboard//police shot north har-bour//this situation has been locked up///something for the the strange old deck up there////in San Bernadino///Mafia relative in San Quentin///what cousin said will make you cry////occasional comments M Cornere respiratory physician///Its Avery ( female hedge cutter )//there is no spiculation ( young an)//Kasslers getting millions in interest /accounts worldwide/hired professional forger to change the will//Simich says what has been done ( kassler niece?/Simich discussing Mein Kampf ///Waters was a complainant ( poss ref to H Waters formerly of US Embassy in Wellington//why Mo Kassler destroyed you //comments poss Obamas and American group//evidence from Hawkes Bay//
Its Vicki Bone////Israel discovered it’s a high crime//Its Bruce////think the blakes don’t like nutty relatives//something in Alans private life///dog breeze had a haemorrhage///why Simich is impos-ing///Mrs Simich says you wont be going there again//what the police discovered about Bidens.///why Simich punished a lady//instructions came from the Carroll family////why it’s a blatant knockoff///Miss Kassler says you are going///details of deadly contamination///pressure from Mr Ophert///psychiatrist says its that nut//Mossad destroyed a family///parent said why we wont help you///Simich released M.O/////////what did the police tell Fruean//police taken advice from Bruce//the kasslers definitely effected assassination///the truth at Harts///we are the police ( female low voice)// //a murderous police officer//instigated a Karori psychopath///Kassler paid 5 million for a house///memories of Polashek ( former employee of columbus line Sydney)//Miss Kassler has to prevent//Bruce and Mary did something underhand////discovered the remains of them ( Kassler niece?//police might see Vicki Wilson ( female Maori)// daughter said Melitia threw the cat at her///Simich specialises in dog starvation///Israel sacrificed Northcote// why brother lies//when Simich began to destroy the situation//Israel prevented further hundred thousands////
remember Janice///this is Agatha////// we have been told you will be sent to (Maori female)//Melitias cat ran screaming down the road//requested details from Kelly Flavell//Alan said vicki stole the money///received secret info why Simich implemented drastic///royal family////Bruce discovere distys service//details of a monster with Standidge////Begley thinks gets words mixed up (well spoken female)//it’s a repeat incarceration///Its Mary////this case with Alan Jones///this is a relative of the Queen ( Well spoken female)//this complaint about vicki is there//Mossad says its another six months//the former US president////this is the Montpellier family//Sister Philippa noticed something////Bruce met Kaeo ?///Miss Kassler finished off a little girl//what we are waiting on ///discovered why Maori ring///cousin said psychiatrist made us experiment on family///somebody sacrifed a blond man/// TL on the blotter///Mrs Simich says you will go ( female well spoken?///Beatrices husband runs prostitutes ///keeps her locked in apartment///needs the money//photos of parents with their heads off////One of Melitias cats at the neighbous distressed and covered with blood////objection of Jacindas family//Neve visits police-gives him presents//This is Mary Birdsall ///something discovered after gyno surgery//////royal insistence////sunset sacrificed////Mrs Simich doesn’t like guinea pigs//insistence of Bruce Wilson//British psychiatry knocked off//Bruce moved slowly toward the court house///Kassler said Vicki has to be disabled///Kassler ripped pages out of the blue book///have oxy-acetylene torches///harassment from hospital//wont save you ( Middle eastern gent)///strange details about Mo Kasslers marriage-he used to go with other women///you are for torturing ( british gent)//Mossad think is the Middletons///
We meet Mr Dacre ( Kassler niece?)////Melitias delight-not sane////Alan started getting payment from FSB///Why Mo Kassler keeps trying to get rid of you//Mo K took the cable car//Fruean asked to watch what she does// Pat tried to destroy the Tidmouse family///the psychiatrist of Constance (Bensemann)// ///Joe Kassler meets Satan////Nuts! ( J Blake)///Anne Simich began ringing up all the neighbours///you should be a mental patient ( young man)///Krtshcil finished off a family ( poss police officer)//Mossad said this cat is leaving family//police going to get rid///police don’t want her on our patch ( Male police officer?)//police evasive about a discovery in the 60s/////different game plan ( young man)////Israeli psychiatrist taking Breeze ( a bulldog formerly owned by Shannon and Candace Beach///a case full of iniquity//received the original from the Kassler family//you need to go away and die (Maori female//Candace lost the baby -rushed into Meree Stewart///baby had cuts to legs//// M Kassler bombed a plane///everything with the psychiatrist///? Conspired with a terrible scientist///you will die soon wont get any older ( Maori female) details of Vicki in the de-sert///psychiatrist tortured Beach////Bruce stole 5 million///Alan bought a spec near Orewa////somebodys blowing off ( young police? Officer)//why we have conspired with a terrible liar ( pos male police officer)//police don’t like Rosemarys intervention///old being got rid of //supermarkets Takapuna: odd comments from remote viewing persons///
/Bruce destroyed Rosary//its bad Ashley/ photo of pat swinging a head//Simich finished off tests// Covid in sewage///Mossad displaced nikki Retford//Mo Kassler destroyed an actress//police have now discovered it’s a shocker//why Vicki has been sacrificed -have been told///Dacre said she hasn’t seen///your wicked nonsense ( female well spoken////why Bruce didn’t find it///// Nazi Goering used to live out here//// ////Mo K said photo of pretty little girl in lavatory///GP said your case has been sent to Wellngton///the harassment of Stirling///Clem said why she should go to Carring-ton//Its crazys pictures//////Kassler running around with Laboratory staff///poppy has been selected -the cat has been blinkered ( one of Melitias cats)///skeletons in a lawyers office////had vaginitis (British female)//Bruce and Mary changed the little girl///////you have been rolled ( British gent)// discovered terrible lies of medical///Alan used to meet conduits// Mo K said its rubbish///why we are getting away with it///this is Dacre ( [poss P Dacre)//they stole money from little girl//seriously brained Olivia ( British gent)//atrocious photos of Joe Kassler and family//Melitia gave something dangerous to Poppy////Bruce met Dacre/////simich taken Malie ( Meree Stewarts cat in whangarei)//
Vickis psychological test ink spots -with Mo Kassler///Kassler starting human sacrifices//Is a medical scientist//Kittys death will be a blow (Briish woman)you have been chosen for mutilations ( British gent)//Chapmans basement details of burials///what they do with the physically and mentally impaired////Go girl ( female black American)// ///police department don’t like religious ( male police officer//////Gerred had a lot of botched ops///Kassler strutting around Rodeo Drive had an address/////harassment for Egypt/////instruction from high medical not to assist////Dacre finished Vicki////this plane met Justice///police she hasn’t had her antibiotics//Miss Kassler had to prevent//Kassler has to break Wilson//doesn’t realise why wicked machinations ( Maori female)//photos of Simich attacking girls///photos of women in sex positions////photos of women in the shower////this commander does not like misfits ( young man)////Bridges told lies about Vicki Wilson///Hid a shadow in the lung/////Mary Wilson has details of experiments///police say wandering in a dishevelled state( Male police officer)///psychiatrist didnt appreciate the advice of Michael Puttick///police? Have taken expermiental schedules///why Satan chose blond ( Male police officer)/////this complainant is Maraitei ( J Collins?)////doctor said it might be swollen ( Male police offcer )///found the angels car////a court deposition///
why you will be terrified////police don’t like those prayer cards////know you have been left to die ( poss young police officer)////Mrs Simich said I am now grabbing all Vickis stuff////what the police have been doing///terrible gangs in Jacindas place////relative made a deposition/////doing ruthless behind her back////lies of a wicked Palestinian////why Vicki has been diddled////Mossad said its stomach( British woman)//your friend has gone to a chamber of horrors///you don’t realise what Bruce Wilson///Mossad discovered why they were knocking her off///did Mossad get rid of danger-ous puke////Melitia is a highly trained shyster ( British gent)//the findings of John Sopel (BBC US)////Mo Kassler decided to blow up the bank (interviewee on RNZ//that is the end of the angels (poss a police officer///you have been rolled (British get///Alan took a little girl to institute of technology////you have been committed ( female low voice//////it is leukaemia ////////what is hidden by Jus-tice///its John Key/////why Vickis isn’t tleaving( Maori female)//Mrs Simich said why you wont go////need to look at somebodys urine ( poss E De Beer Waitemata DHB///the Wilsons were renegades in Palestine//////Mossad thinks its 20,000///British security hates lets off ( American female)//spy lichenstein ( American female)//Mo kassler waiting on Vickis unit///parent stole money from little girl///
you don’t belong here ( British gent// its her poop ( young man)///its Bruces rort///////something odious going on in the background///Israel think its cancer///police don’t like antibiotics/////Simich thinks its your poop ( British gent)//Mo Kassler going to Potsdam///going to meet the Queen//Clems psychiatrist wants to see you///photos of dead bodies ( American gent)////Mossad thinks why Queens is looking into it ( unid male)//its resident//GP has details of deadly substances/////Israel discovered something at Wilson baby///you will have to get out ( poss male police officer)//Miss Kassler told Ann Simich she really enjoys kicking felines////Begley is a thief/////this program is full of curses////Mossad discovered Royal Doulton////something despicable hidden in Alvin///wife of Suffolk found dead by the pool-shot?/////husband discovered she had another child///Slabov in London///CD had film of their marriage///Simich visits Grinlinton//bizzies finished ( Maori fe-male)///psychiatrist released a certain detail( Maori female)///you are being committed ( Maori female)//I have seen your will ( British female)///this British lawyer///Its bungling Mary/////Clem Simich garotted Fairley (Interviewee on RNZ)//British tried to hide where she came from//are you harassing work and income staff///Bruce told lies about his sister -said she gipped him///Bruce said you cant take over////Israel didn’t like the complaint//Mr Casey ( British female)///It’s a cop/////Italian?said when they were changed///Simich has been making strange enquires//Kassler is going to destroy effigies ( Kassler niece)//a litany of false ids ////Mary of Tech////relative watching ( American female)///MI6 might find you some money in London///Mo Kasssler changes signatures///this is signed V Wilson////Mrs Fruen is not satisfied with Vickis background/////discovered Alans sodomy/////Kassler child picks nose all day///Kassler said the next one is Lhasa fever ( British wom-an/////Ann Simich has taken a brilliant dog///details of parental changes in Clarendon ( st heliers).//////Pat wife suddenly took a plane///what you and pussy have to put up with////she isn’t going ( Maori female// this psychiatrist ( well spoken British lady)//never known a case like (American female with a drawl)///Mossad thinks she is a flake///they have assassinated Vicki this time ( young man)///police say we know there is damage to fart/Harts? Mind///Mary Birdsell said your scan had a lot of scarring -contained a number?//// Mo Kassler and Ann Simich ( remote viewing at the Countdown)///where you are going ( Chinese male passerby aged 30s)//FSB killed pilot Chignall///you are not allowed to leave////simich is getting a cheap house//this is your Auschwitz relative-older woman///Germans are nuclear ring///she isn’t sane ( Maori female)///British received details of the Vicki bastard//Ms Simich said a neighbour said Vicki is disgusting///need to see the will ( British female)..pressure from vicious Suffolk////Miss Kassler assessed Vicki as a covid suspect////there seems to be poops in an aliens bag ( young woman)///the police commander sacrificed mental//// ///psychiatrist watching (tall young man black shoes socks and shorts at BP connect shop//Haumaru sacrificed lunacy///Simich instructed headaches///)///
Delphine caused trouble in Whangarei//Its Bruce and Mary//Mo Kassler had a horse in the basement nearly dead///something hidden by Standidge///did the police sacrifice your books ( young woman).////Simich sacrificed another friend//British chose McKenzie///Kassler seen strutting around the Huia dam///cruel lawer//psychiatrist received details from Moscow//psychiatrist said she has to go///what vicious did with McKenzie///what Simich has done with your lawyere//Mrs Simich going to destry the tyke///Mrs Simich said Vicki has to f..k/////Its criminal evidence//police gradually increasing pressure///Vicki has been selected for a terrible bashup//Mo Kassler after a shield//////discovered danger in Krtschils//Dog Breeze found shivering on the bank/////police commissioner contacted Australian police to discuss Vicki//I/ts Jacky Hunt///a bag of childrens heads//all points out for Ann Simich///Simich shot Bruce///why Ann Simich wont allow mentally impaired peo-ple///Bruce rings police ( male police officer?//// Simich said you will go///Simich d idnt like Barkers involvement////This is Orlov//John Kennedy lied to police//Did Bruce ring Ketteridge ////Melitia had photo of Vicki in airline//psychiatrist hasn’t told her///Simich going to force treatment///Mrs Simich has a fat beagle//Its her poop ( British man?///Clem Simich committing yes he can////Mary is committing//Lots of info from Daysh///
Vicki needs to see complaints//Bunny Wingfield found dead Paris//Candaces baby screaming-she had other sex partners///police discovered Vicki Wilsons id//knocked off the psychiatrist from Shea Terrace//old Wilson was a convict-larceny conviction//black marks in Wilsons house///Puttick wont assist ( British gent)//Israel proved container a shocking liar///Kasslers running around with British staff//discovered it’s a murderous shunt//senior medical meeting St Marys this afternoon///police said it’s a lonely sadist//you might get terrified( Australian gent)//why did the police hide something///Chinese husband at a meeting with PolPot//Kassler meeting Bramley///New Zealanders will be relegated to camps//Michael Begley made the selection/// Pat Wilson slept with a specialist//what angel is hiding//Everards records /contacts//Bruces wife use to f..k the president///China must destroy this happy cat///why the psychiatrist has ended that///Mossad said you will go///Mrs Simich stabbed an angel years ago ( American male///)///taken advice of British psychiatrist//police might see the farter ( Catherine Ryan RNZ//
/)////you were sacrificed by Mrs Puttick ( British gent///where did I find a Karcher -insistence of Bruce Wilson( ( male police officer)-a Karcher water blaster was one item among my personal effects in storage in whangarei/////brother insisted on murderous ruination///Mr Dacre said its new evidence///Scot said police need to bring her back to Wellington//Kieren thinks ditsy didn’t see///this is Throll ( British gent)//this is Nana Whitney ( American female)//Mr Simich contacted a senior psychiatrist///something fiinished off Dr Crippen///Simich has a Mossad graph//why did Israel get rid///threw them into the moat////discovered nuclear waste//comments S Gerred? Breast surgeon Waitemata DHB and police?///////brother said its an unpleasant surprise//Breeze hidden by an American//Melitia said getting rid is easy///Satan has taken Australian kids///Ann Simich chose GP N Retford////Jack Kasslers sex relations with member of the Himmler family///Meree Steward had a dustup with Ann Simich//Evers discovered something in a photo////doesn’t realise the worst -Chinese getting rid ( well spoken female)//
the Liar was FSB///this country is going to be put under extreme pressure//Bruce asked Simich to question Vicki///psychiatrist punished you ( African? Woman)//Reckoned Sim ruined the practice ////pressure from t/////what he Birdsall family//////this pilot doesn’t like nut cases ( American male?//Mrs Simich said why you wont get out of here(Maori female)//senior Bio visits Mrs Simch////What Mrs Simich is waiting on// /discovered Vickis papers screwed up in a hole in the wall///Clem Simich waiting on psychiatrists assessment of studio//psychiatrist has been getting stuff from a reactor( guest on RNZ)///torture ( Middle Eastern gent///police shafted the angels///Kassler destroying joints///you wont go there ( Maori female)//Haumru Staff blatantly lying about Vicki ///this shift will frighten Bambi///debacle at Beaches-baby distressed left in nappies -dog Timbr crying//////Beach was involved in hazardous///photo of politicians with knives in Simichs portfolio///a certain doctor has been knocked off///did Eastridge get rid of her ( well spoken gent)//Bruce said what would that involve////Mo Kassler said Vickis mother had blumental/////we don’t like the poop lying around ( Maori female///Simich got rid of her ( well spoken woman)//Mrs Simich suddenly wrecked Vickis Wilsons situation//Israel said you have to get out////something fell off the bridge///police staff dodging the family//you are Russian ( Russian gent)///you will go to the depths ( British gent)//Bruce told TVNZ to watch Vic ( Poss J Wells TVNZ)//what your mother did ( Peter Gluckman)//don’t like you contacting anyone else//Mrs Simich delivered explosives//Graces mother was nazi///a neighbour signed///Clem Simich was setting up a petition///death of angelic prin-cess//frater said the assassin is Blake//seizure in Whangarei//
St Heliers has a sink hole///bi-polar no longer living-poss ref to the child of Melitias cousin Jessica ( British male)//why Miss Kassler has her books ( Kassler niece)/////why you were committed ( British gent)//Ray Kassler had contact with the Luftwaffe///Ann Simich going to use it//she has to go ( Maori female -deep voice)//you have been framed////you have lost cat ( Maori female)//Simich is going to assassinate tired///Paul Dacre finished you off//bad stuff then police took her away//should have been an heiress -got down on the money////Mo Kassler is the plaintiff//Simich thinks the situation has tanked///I am Queen Mary ( British woman)//think relative will end up in the poor house///destroyed a little blond child -ripped to shreds///Israel say its Apia ( interviee on RNZ)///parent died-a bit strange isn’t it ( poss male police officer)//Bruce thinks sister might have a heart attack//something at Sunset (medical practice)//////Pat Dallas said you were a good tennis player ( British gent)//details in Sinatras file///Bramley leads an amoral lifestyle///)/////instigator was vicious Handley//you will go (poss African female).///////there wont be any Neuro ( young man)remember Sister Dominic///Hart ( poss Anke Feustel of Sydney)//police need details of your transactions////its Silk ////
Psychiatrist ( kassler niece)//why she wont stay ( Kassler niece)//Devonport destroyed our client///Simich killed Fairley////Mr Al Qaeda wants to cut Vicki in half///going to confiscate all those//you are being arrested////blood spots in One Health//Its podge (young man)//an instigator is a relative of Costa/Coster?////destroyer rat pack///Harman said she was a selected sacrifice ( well spoken gent)//somebody needs to flog of nutsos( British gent)//Israel think its Jeremy///Its Knickers ( Russian gent)///Ann Simich has school uniforms tried to h ide them in a bag//you will be murdured ( female low voice?//Begley got rid of Bruce////Susan said its tapestry///Begley visits a doctor ( Russian? Gent)//Simich is cutting a bastard ( Russian? Gent///the angels youngest is dead ( unid male)//its gethsemani( British female)//GP having disucussions about this character tomorrow ( British gent)//police sacrificed cruel dad( British female)//Ann Simich has nerve agents ( British female)//this is not the sort of response I would have expected from a medical practitioner////scientist used a little girl////Alan conspired with a scientist///Kasslers now asking permission to break in and take Vickis possessions//Kassler relative is brainier than you ( Kassler niece)//a senior cop burst///this is B Snow ( prob B Snow)///entrapment of John///what has been hidden//Simich convict-ed an aberration ( British woman)//breaking up this pair ( Poss police officer)//police noticed you don’t cough up ( male police officer)//Vicki wears sweats-used to be as as smart as paint//Mo Kassler was specially trained in tormenting and goading ( well spoken woman)//Miss Masters ( female poss Director of Mental Health )//Bruce said she will get three weeks//this specialist is not happy with neurology///we are ending this sacrifice)TVNZ)//you will be horrified ( British female)/
/why a senior psychiatrist got rid( British gent)//something hidden in Gracefield///its another birth certificate//something in Nancy Sinatras-address in Bel Air?////fate of a mental girly ( male police officer)///why she doesn’t meet staff ( Kassler Neice)//bizzies finished////this cat is in danger//Mo Kassler visited a dungeon in Paris//Mo Kassler settled in Croyden//Israel tool the advice of Miss Vamos///Simich sent a summation of the case to Biden///Know its Marilyn( Italian gent)//think it’s the identity of scallywags//Kassler tortured breakdown children//Mo K broke the chain at the police toilet//Mo K has ids of the royal family//Mo K has left the Croyden place//small traces of plutonium in NZers blood////Kassler rings the Minister//little girl on the list sat with terrible scan-ners///Bruce repeatedly rang Mo kassler//relative of Constance ( Bensemann?) runs a mental hospital//Its therapy ( well spoken female -poss medical)//what has happened with Vickis crap ( American gent)//Israel going to arrest you//we have got a dustbag ( young woman)//M Kassler said she has to be tortured///discovered pretty on railway///discovered something in Rodeo Drive -why you will leave//what your mother did (Dr Peter Gluckman)///kassler running around with Wyness psychiatrist visiting Anzaac street///Its High Parshenko ( Russian owner of hot roast shop Kitche-ner road Milford////
kassler visits WINZ//Its Mrs Begleys witchcraft//Its Nancy( female american)// discovered the identity of Christs last child//Simich visits Devenport ( poss my lawyer)//JFK watches the bastard ( American male)///what is left of your stuff( young woman)//you have been selected ( British gent)//Simich said Vicki isn’t stayig///a little girl is tonights sacrifice///that is the only assistance fair will get//Insistence of Mahuta (Minister of Foreign affair)//psychiatrist says you wont go-your psychiatrist///someone rings Biden///it’s the end of glamorous-a bombshell///Mossad lost a daughter( Russian female)//Suffolk brought out a little girl//Sims misappropriation of practice funds///relatives went into the moat//Nick goes with Wendy//Did Nick Parshenko meet mental hospital//Isil forced a ship//the psychiatrist says she isn’t sick ( male softly spoken//go to court ( older man)//Comments Biden soundalike and companions////parents skeletons//apparently in scientific pro-gram//Mrs Simich says you wont go//Bruce said she doesn’t have much capacity//Because Mrs Simich says so -yes she does ( Maori female)//Bruce Wilson advertises on the dark web killer to hire////Bruce and Mary own 5 properties Century 21//when Kassler started tearing at flesh///Mossad will take over Bruces property first//Nick Parshenko is going to destroy HP ( Rusian gent)//Harts excrement ( Russian gent)//remember the Aldriges –found in plastic in a creek in Paraparaumu////Simich thinks she h as your valuables//Ooh (prob Jan Stokes////there has been an urgent meeting at Sunset//Lies of JFKs wife//Its farty( Middle eastern shop assistant Countdown Browns Bay/////medical attend covens//simich said mental cant stay//Brucey is wealthy ( Russian gent)///discovered serious skullduggery//FSB nixed a young mum//there is a microphone//
the Wilson lady is hard headed ( Russian gent)//police identified ditsy gave to QC/////Clem Simich finished looney ( Maori female)//Simich hasn’t finished it yet//Miss Wilson making depraved comments ( male police?)//Andy Coster congratulated Simich//Vicki lost a pile of books//Pete said it was limited//Kassler hammered a large pit bull( RNZ)//British psychiatrist is a shocking monster//the writer is Erenstrom (former Director of Medlab)//a favorite has been slaughtered//info has come to light why you will be killed// Nut case didn’t meet psychiatrist ( Korean female resident of unit 9)//parent was going to knock you off//Its high crime////Cambridges daughter went off in a furniture truck///kids hiding//British Intelligence ( Male British)///Mossad wanted Vicki isolated( British gent)//waiting until Simich cuts here//Matey was sacrificed by Masters (senior mental Health)//local psychiatrist contacts Masters//where low savings is going to ( Russian fe-male)//cousin beating an old elephant////what the angels daughter is being subjected to ( older woman)//something in EBay/// what was in a local govt office///it’s a precis//realise you wont aware of it ( young girl)//It’s the bladder ( British gent)//Mossad discovered its your signature//Simich pulled it off///this is cousin Debbie -my husband doesn’t like maniacs in the family///what Mary buried///Miss Kassler ruined Ollie)///your vase in the Tomasons///psychiatrist has a reel might let you see it ( British gent)//smell of burningg flesh somewhere////shot a little girl in the eye( British gent)///you will never own ( British gent)//the Kasslers have Honey///the specialist didn’t realise she was assessed as schizo///Jan Blake knows when////why she has been genocided///police discovered something terrible concerning you////Russians running J Blake//Mo Kassler knocked off a Spanish family in the Algarve///Simich picked susy/ Mrs Simich says y you wont have a chance//why Jan Blake causes trouble//cruel f….ks ( unid male)
///the Russian princess hasn’t seen Cindy for a long time/////Tony wouldn’t answer the questions-wife had pages of contaminations procedures///lost Tiggy dog//Australians say its something shocking/( interviewee on RNZ)///think parent indiscreet///angel child says where is their dog/////Angels dog Honey was a great favorite///Nick Parshenko meets your lawyer terms of engage-ment///This is EJ ( middle eastern gent)//what did Meree Stewart say //sex complaint ////Agnes says she is in danger( unid female)//this is genocide ( Australian gent)//Its your Maidenhead ( unid female)///get rid of cat ( young man)//JFK might take brilliant Israelie out( American gent)//Dacres been knocked off ( young man)//waiting for something to have effect on vicki//why British psychiatrist (f TVNZ)////Israel discovered a relative trying to get rid ///the priests like Brendan///discovered what they h ave done//It’s a huge growth ( unid male)//carcases found in a ford territo-ry///It’s a microphone( Russian female)//Miss Kassler doesn’t like evidence( stridthent sounding female)// Kasslers seen running around with laboratory staff//something tipped over the head of angel child//Its Middlemore ( unid male)//Simich visits abbatoirs ( Russian gent)//You need to put the rubbish out ( young man)//Simichs psychiatrist sacrificed everything ( kassler niece)///objections of Riyadh/police say its your stools ( Maori female)//Its Carrington//a very wicked princess //police say Vicki must go( Maddie TVNZ!)///Its poosey (elegant older woman long grey hair commenting to the receptionists North Harbour practice////Mo Kassler has details of Chamonix//terrible details hidden by Asia//think Vicki has lost a Karcher//Mopsy said its due diligence//do you h ave proof of purchase ( unid female)///
the insistence of Prince Charles ( British gent)//Mrs Fruen has details of your finances ////the Marquis of Dorset (well spoken British man)//this is Clem Simichs psychiatrist ( Maori female)//your chickens have come home to roost ( British gent)//cat frothing at the mouth///police think she is hassling IGIS ( young man possibly a police officer)//police discovered [ackets this is senior psychia-try -police say you sleep with your cat///The Fenaughty family////police need to see diagnosis///list of complaints about her wit h police//you will be committed ( Black American lady)////An Australia said you have to die///psychiatrist visits Hart ( Australian gent)//why you have been framed ( strident sounding female)////police say its your poops ( young man poss a police officer)//Miss Fairy ? had a breakdown ( Jessie RNZ)///Vicki will have to dispose of long hair ( Kassler niece)///the lies of the offspring of the Hazards///Mrs Simch hired a young man to sexualise young girls//British psychiatrist cheats//Its Hart ( tall Chinese man in supermarket?///she sits inside stuffing herself ( young man-poss police?)////Gaby Clezy chatting to police-ran projects///the death of the pussy cat (Kassler niece)//Simich getting rid of your buttons//police say why we murder old women ( unid female)//Bone said something wrong with the bot ( male police officer?)///Vicki must go with pun-ishment////Simich said why you cant survive( unid female)/////you have been short changed///Karen told lies to the police///Middle East quickly left Sandringham-discovered high toxicity//
/photo of Begley meeting Case Westrata////bodies on a slab///Simich made a satanic promise concerning Vicki Wilson///G Clezy with police financial irregularities////Israel meets psychiatrist//this psychiatrist asked to watch what she does///Karen meets scientist-Strong st///you haven’t defecated ( well spoken British gent)////it’s a haemorraging family ( Kassler niece) ////// this psychiatrist will have all of those ( female low voice)///Miss kassler came w ith the Director of Mental Health/// odd comments small group poss TVNZ /////Miss Kassler wants Vicki incarcerated( American gent interviewed RNZ)///Achim Drescher – is Nazi -marriage breakup///////simich thinks you are gross///wont see this GP again///found under Marys floorboards////she might suicide///Simich said I want her broken///Carol Lombard////her daughter//discovered a schedule of Frank Sinatra//This is Mrs Bethune///police have picture of an axle////medical trying to get rid why you don’t know//priest said she is going to a dungeon( British man)//Simich said Bruce hasn’t seen//the angels dog///why you have been selected by devil worship//psychiatrist thinks its regression///a lawyers psychia-trist///Kassler niece prevented a journo///Kassler destroyed one of Jesus Christs descendents/////the Kasslers have been advising Haumaru//something hidden at Melitias place///records with Mrs Simich///Simich poked eyes out///you might need to go the loo again ( unid male)//bodies contained in a humber super snipe///Begley has been a very wicked man///Mrs Simich doesn’t like Vicki getting tablets///wishes of American president ( maori female poss Nanaia Mahuta)/////why Mrs Simich is waiting ( Maori female)//Its jaundice///Simich says she will have to assassinate cat////details of a French couple in Mongonui 1800s////
something you are not aware of ( well spoken man///Mrs Simich said y our cat will have to go to the SPCA////Miss Kasslers sister did a jail term//s Mrs Simich said you will have to forfeit//Mrs Simich said you will be going to court///you will come with us (British gent)//this relation is ermine ( Mr Chapman RNZ)///Its fairies bedroom ////Mo Henry discovered something in Ann Simichs////scientist took a little girl////discovered its Ebay//////Russians were running Eileen Kassler///Mrs Simich destroy spines
why a community manager did it ( Maori female)///it’s a home truth ( British gent)//comment a Biden soundalike/////angels dog has run away from the new place////Vickis going to Kowhai ( kassler niece -poss ref to a ward in mental health facility)///Simich said what goes on after midnight//Ann Simich said need to get her out of the way ///police photographed Simich in the act//discovered why they are knocking her off///Harry Kassler was a well known nazi agitator/////police concerned about bathroom noises (male police officer?)//Israel says its Vickis displacement ( Russian gent)//Miss Kassler said you will go to Carrington ( Kassler niece)//parent thought she was a bit of a nut case////Alans fault////the priest said you are going to die/////why cousin set up////the lies of Bruce and Mary Wilson ///you are getting packed up/its bijoux ( unid male)//Mo Kassler sacrified loaves//you will have to pay for it///Mossad said you will have to pay for it///police commis-sioner said so///Asia meets khmer Rouge////stole money//stole angels money//wearing ermine is a lady from Brentwood//police didn’t like the big story///
And Now ( B Obama?)/// another dog has been sacrificed////why Mrs Simich sacrificed the lunatic//relative of angel may never walk again ( British gent)//received tapes of Miss Kassler///why its Farah///its the British psychiatrist up the road//you have to be committed ( Mo Kassler)//Alan used to visit the pink lady///angels child is screaming///money stolen from imprest acct////dead young woman in the area of San Clemente///////taken Vickis papers from Ann Simich///Mrs Israeli hits bananas///Bags of money taken into Simichs///money switched from a Washington bank///Simich running around with your GP///Ann Simich sent through to Melitias mother///this psychiatrist does not like Vicki getting medication ( American female)/////Israel visits Hart///Al Qaeda thinks it’s a cheeky person/// /what did Simichs psychiatrist do///why Vicki had to be assassinated///Simich trashed//Its Neck (male passerby)//something hidden in Landon Lanes////British psychiatrist gun running///discovered Peters corruption////Alan had been married before////Bruce owned a brothel////British has a boom box in the lavatory//
Mrs Angel fell down a 40ft cliff///think they tortured her sister///it’s the Israelis wife///police disposed of all tapes///Diana had a wicked conversation///Michael Begleys number plate seen in the vicinity//we are going to finish sacrifice in opaque ( Kassler niece)///police think its her history///TV said one of her lungs was quite shrivelled///Simich gave something to G Clezy///police say its jewellery///your case wouldn’t be diagnosed///Mrs Simich said otherwise brainless///who has been siphoning//you have been rolled ( police? Officer)///wickedness of a American//it’s the doctor ( male -police?)///Its Jimminie/////its another certificate///why she has to get out ( strident female)//doesn’t like prayer time///Kassler has details of contamination in urine//SPCA will take long suffering mittens//the liar is a ruthless secretary///Russian on a bicycle//Bob Thompson -contamination procedures//Mrs Simich said she wont be going anywhere//Mrs Simich said why you will be locked up ( police Officer?)///why you told lies ( police officer)//police don’t like the complaint/////Vickis lost cat//Australian sacrificed///something of Sewells in the gutter///Simich checked your money today/ Mrs /Simich visited Barry Snow///Blinken in video////Al Qaeda going to sacrifice Christendom ( interviewee RNZ)//Simich discovered something in ditsys account///relative of Anita Eckberg///dangerous Benseman family///your brother will have to be told///Vicki might commit suicide ( well spoken British woman)//////Susan Kassler used to do something with daddy/// screams heard at Beaches place///Ann Simich said they were both duffers ( well spoken male poss British royal)///Ann Simichs cat has pneumonia -gave cat to the Kasslers -used glue///One of Mo Kasslers staff in a knifing incident in London////Miss Kassler said she drops things///wishes of Susan Kassler///PM tortured a man in the past///he hadn’t realised why she was unfaithful///she is very frightened////photos of Alan straddled over a woman///knitting books in background///
this Russian meets Hall ( Russian female)//this means you will have to leave Auckland//because I said so ( poss a police officer//police commissioner sent this back to IGIS //why the police commis-sioner sacrificed an old woman ( J Mulligan RNZ)//Vickis chest phlegm////Mo Kassler a friend of the butcher of Lyons///police discovered photos of your pants///Alan Wilson told lies///neighbors think they heard a vicious scream// Bruce said what will happen to you ( well spoken woman)//your rout////think its Ola////Melitia said you wont do that ( Maori female)///Mossad banged Pat Wilson//Simich said why she wont ever come back///complaints of doctor/both doctors//police commissioner wants Vicki interviewed////reason you wont survive ( well spoken British male)////Miss Kassler asked to go through your place//priest thinks Vicki is potty///you are not mentally equipped ( British gent)//a monster paedophile ( Kassler niece)//we have seashells( shells in my personal effects) ( Kassler niece)//;psychiatry might have to get rid of it //kassler advised tests were falsified /////police say its extrusion ( British male)//this detail means Vicki is finished//British said you will go to Carrington//why did Simich get rid///why bizzie doesn’t know ( Maori female)//
Mo Kassler has 5 million in a London bank- the bank said it was an irregular entry-money originated in Rome/////Its eradicate ( f)////Its Tenko ////Al Qaedas mother used to steal children////Simich said why ditsy had to go//misfit/////its ruthless Blake///discovered shocking repercussions///Mossad destroyed evidence of high angel///Mossad said it’s the death of a woman///the Lundy case-tape/////details of Marfans with Mossad///police say you have to stay here//Did Mo K meet Constance// you need to see police ( male police officer with a deep voice -bathroom)///instructions from Mrs Simich//destroyed a dogs excretory///Mrs Simich asking for details about the nose//I met Mrs Simich ( prob Dr Thorpe)//US sacrificed the prince//Ann Simich will have to take garfie (RNZ)///////complaints to mental health//Vicki has to use cough mixture-might be a danger to clients ( Indian?/Middle Eastern ? shop assistant-Countdown Hauraki)////police shafted Sea-mus///Israel mutilated a horse ( young woman)//police department stole a packet of money ( well spoken female////parent from the Ohmar family near the Tigris river ( young woman)///Mrs Simich might sacrifice your independence////it will kill you /////Sim gone to a job in USA///money came in from Sicily//Load of woolly woofters ( young man poss police.///why Simich wont be tipping the balance//the wife of space committed suicide///Bruce said his sister is going to//stillborn child( American woman)//Biden has been forcing///carefully monitored scientific program for the Wilson family///this complaint hasn’t seen the light of day///Al Qaeda threw a child on the fire///Mossad used San Diego ( female Russian/middle east?)////Al Qaeda doesn’t like Christians ( middle eastern gent)//Its Ashburn psychiatrist///Clem Simich likes breaking hearts//it’s a scientific analysis///Mrs Simich said why you will go blind///Mrs Simich said these details are why you will have to go///Miss Kassler wants to start massacres//J Ardern descended from a senior terrorist///Priest said …compromised//they read a confession from someone//harassment from Barbara Goalens offspring ( famous London model of the 1940s and 1950s)//////you like living dangerously ( Russian gent)//
its trouble ( middle eastern male?)//Doone said we cant have this ( P Doone former police commissioner)// sick of the west (Middle eastern gent)//dead young woman in Los Angeles//pressure from Linda Sacklins family ( Sacklin a former pupil of St Marys Wellington)///pressure from Barbara Stanwycks family////something wicked has been done ( Kassler niece)//Vicki will be bashed up ( unid female)//Philby hid a most terrible case///this is a blind doctor//Vickis blood has strange patterns///you will be mutilated ( middle eastern gent)//dangerous transmission ///Bruce said his sister has got a nice place ( middle eastern gent)?////its chap Isil ( Russian gent)//we will have to eradicate ( middle eastern gent)//why there will be a lot of graves in this country ( Russian gent)//Israel watches keepsakes ( middle eastern gent)//you will never leave ( well spoken woman)//British ending the life of rusty///this tape-bulldog finished( British gent)//the killer of a little girl///father of Craig Thompson/////writer is a terrible nut case////Bruce said she isn’t prepared-stampede ( British woman)//why Simich is committing ( unid female)//Mossad destroyed a bastard//Bruce and Mary own a number of properties in in NZ -have used Century 21//Ann Simich? Keeps details about Satan in the refrigerator////
why you don’t know why (unid female)//its really too embarrassing ( Russian male?)//FSB kills young women ( Russian woman)///force ( police officer)//why you wont get away ( unid male)//complaint about her at the hospital( Male police officer?)//Mr Simich said why you wont be there ( you woman)// Mr Dacre lost his case ( unid female)//teenage rang and said it was Trudy dog(unid female)//police say its trolley ( Indian female shop assistant countdown Takapuna)//Russians said Bruce has to do it ////you need to meet Simichs psychiatrist ( unid female)//CIA -JK didn’t want any strange baggage ///Mossad think its an insert//something in a batch a couple of weeks ago//why you will lose your life ( American gent)//directive from Clem Simich ( unid male)//it’s a terrible PM ( unid female)//Simich said why Vicki has to get out ( British gent)//Its Paul ( poss Mr Dacre)??/////Dacre got into terrible trouble ( unid female//you will need to push out some s….t ( well spoken man)//do( unid male)// Timbre crying in Kasslers laundry ///why Dacre cant handle your case ( well spoken gent)//shot British (unid male)//they will make a decision about pants tonight /////photos of a strange girl ( unid female///Bruce will get killed ( unid female)//Biden received a certificate ///Simich said that is exactly right ( older man)//police cant save minds family ( unid female)//angelic family went through the crusher///ditsys id in the Israelis///going to knock her off //trounced Craig Thompsons son //Israeli psychiatrist said there is going to be certain trouble//your cat wouldn’t survive (well spoken gent////twin Begley said it’s the excrement of nut case ( British female)//Israel said she will have to go ( Israeli gent)//Israel think it’s a drastic upheaval //Mrs Simich investigating favorites scripts( RNZ)// Vicki used to wear petticoats ( Russian gent)//Vicki gets headaches ( Russian male)//Mrs Simich destroyed lungs ///
/Bruce had a list of dealers ///Ashleigh made a specific complaint///this pet is absolutely screaming ( unid female)//Mr Brand said next time//Vicki Wilsons farts///she will be committed (J Ardern during public covid address)Vicki Wilsons farts ( J Ardern in a public address)//////Mrs Simich punished ( A Coster police commissioner-quiet aside during publc address)//Miss Kassler said Miss Bizzie is the first one//something bad on the floor/you are not sick ( poss a young police officer)//this unit to miss K ( Maori female)///it’s the reason Mr Dacre wont go to court ( poss Police Com-missioner)////police said you don’t need to see that ( unid male)///Melitia bought an old car -drove to Auckland/wheel fell off//breached the boundary -fell asleep in the police cell with 2 chil-dren///naked phots ( young Australian man///////Bruce tried to destroy the trust//mother of the cat dropped ( American gent)//Its hot ( Maori female)//It’s a killing ///it’s the police commissioner /commissioner doesn’t like complaint///Its fart thing ( female resident of WDS neighbouring property//Its inevitability ( British gent///Its Miss Clarke ( British High commissioner?)
///complaint from Queen//Simich said why she is going//Its Agatha //real trouble///Mrs Simich is starting stiff necks//police commissioner said you get through the tissues//Simich taken over Miss Kasslers place//Mo Kassler had details of a plooty marriage///Olivias father ( Dr Graeme Sewell) tried to force Vicki out of St Heliers//why did the police department sacrifice this nutter//Miss Kassler might sacrifice this QC( Kassler niece)//this is a senior lawyer//the police don’t want online//Mrs Simich said what has been done -it’s the truth//summons to Mr Bramley//Simich finished it off//it’s the bad Wilson family//might have to leave your stuff behind//one of the Kasslers diddled MSD/// details of a bastard with Wright poss Dr L Wright-female announce RNZ concert// pro-gram///why Simich got rid of Vickis place discovered what they hid in St Heliers///Mrs Simich prefers black women( British gent)//watching to see if the s…it comes out cleanly ( Kassler niece)//Kassler serving Bramley//Kassler demanded to see kidney scan ( kassler niece)//Kassler said there are sudden aspects in Vickis cranial ( Kassler niece)///The British don’t like socialised medicine////Its Hart ( Australian gent)//Mrs Simich is lesbian//a complainant is Egypt//this is John Stirling // Bruce said he needs to see what she does//Bruce dumping piles of concrete near the naval base//psychiatrist watch her ( American gent)//Bruce thinks you wont get away//Simich told Alan////
she isn’t keeping the blind down ( British female)//you have been summoned ( British female)//discovered Bruce told lies (unid female)////Vicki wears a big bra ( young man)//convinced one of the angel kids is a bit slow (British female)//Clem said where is all the money ///this pushing ! ( Russian gent)//Arab prince ( British gent)//mixture of programs( Kassler niece)//Simih likes strange stuff ( Russian gent)//Bruce said Mary has been knocked of (unid male)//starting a nuclear explosion ( American gent)//Vicki used to be beautifully presented ( British woman) frequent comments from British gent clipped tones -psychiatrist/////Mrs Simich said you wont be giving up the place ( Kassler niece)//Haumaru said you have to go ( Maori female)//Simich thinks bizzie is finished ( British gent)//Simich gave an instruction //Its official -Mr Simich is why you are going( British female)///brilliant Israeli has been decimated ( unid female)//you have another bin to put out (unid fe-male)//old caravan hidden in a place in Spain//the Kasslers think they discovered the origin of “ Bambi”//Princess Mary of Denmark -the affair with Arab prince//Simich said you cant stop that ( American gent)//you have to get rid of those(British gent)/somebody bashed in a unit in Raumanga//Mrs Simich said not this time//Mrs Simichs information tipped the balance //I will have to commit you ( Chris Hipkins Covid Minister @ 3am )////Morning : comments Hipkins and Medical male companion//leprosy in the background( unid female)//t
he psychiatrist likes the extracts ( unid female)//because I had to destroy the line ( poss Mrs Simich?///the Kasslers crashed Vickis investment ( male teenage passersby)///these are going to be ripped away (unid female)//angel said what has transpired///what Mrs Simich will do with this littlew animal ////Wairau discovered they never sent it //Mrs Simich stole something//Mrs Simich said its ditsys account//a terrible deprivation (unid male)//Martin made an investigation //comments Kassler niece nd British gent (bathroom)//something in Hipkins background//discovered a saga with Wellington police///discovered at Simichs//Melitias cat full of stab wounds ( British gent)//Mrs Angel has been killed //Bruce thinks you might dead in 5 weeks//angel lost his wife//what she hasn’t seen//discovered reports retained by Germans-certain individuals contaminated with smidgin of plutonium//the police have your details ( well spoken female)/British said it’s the laundry-s….it( Asian female on phone in Pak n Save )//It’s a search warrant//Mrs Simich said the stuff came out of her mouth (Maori female)//Simich said you go to a mental home //strange spots ( maori female)//Kassler dropped large packets of bleach//Russian thinks its ether ( Russian gent -bathroom)//the writer is Naden middle east//Its fair Donalds meeting//Mrs Simichs dog found in pieces /Mo kassler used to deal in stolen goods ///simich says she has to go//new rules ( unid male)
//Simich sacrificed an Israeli man//this psychiatrist is extremely dangerous//Simich sacrifces meatballs ( unid female)//Mrs Simich said you don’t need those ( antibiotics) (British gent)///Mrs Simich has been to discuss it with your lawyer/You would lucky to even get a diagnosis( British gent)///you have been banished ( unid female)//Bruce said Vicki will have to hand over ( British gent)//Simich thinks its Tse ( Russian gent)//Vicki had a break in //Ann Simich making enquiries about Vickis insurance//it’s the ring ( female )///details of a betrayal (unid male)//Penny left husband -living with Middle East//Mrs Simich meets Vickis lawyer also Dr Brant///did crazy girl get strychnin ( young man)//you are afflicted with horrible ( British gent)///Israel selected Tess ///Simich said you couldn’t take puss ( unid female)//you pussycat has to go ( British gent)//It will happen again ( British gent)//this sickness is why she wont stay ( Maori female)//Simich said the case goes to WINZ (unid female)//Simich said you wont go there ( Maori female)// what is between the thighs ( British gent)//whereabouts of pilot Chignall ( unid female)///Israeli psychiatrist ordered the destruction of exorcism prayers ( British gent)//Czar Nicholas ( Russian//)//what was that ( female southern US)//this is the police commissioner accompanied? by Polly and JE?)/////its mind ( WDS neighour)//they have been grabbed while away ( young woman)//the descendents of a a fairy in a case//you need to leave ( womens group//Did Mo Kassler meet Dacre//Its Kim (unid female)//this packet is with a madam ( unid female -poss ref to a missing courier package)///you will ahave to get out ( unid female)//Mrs Simich told the angels children to come with us//this tenant will be frightened //psychiatrist said this case is for MSD ( young woman)//why you lost your case ( unid female)//Simich said why you are going ( unid male)/something sinister is happening to the situation( young woman)/you were destroyed by Mrs Webster//FBI interviewing Megan -children tied up//discovered Kasslers are assumed identities//Al Qaeda said porky Vicki is finished( middle eastern gent)/Mossad said you wont like being confined ( older man)//did you always have mental problems ( older man resonant voice//discovered what will cause Vickis death ( unid female)/Its big Marilyn ( unid gent)//she visits Joyce//
An Israeli was crushed today ( unid male)//Details of a fairy woman in Duke of Marlboroughs bag-found dead in the forest -daughter of a fairy family//why the NZ govt is centralising ( Maori female)/Its Mary ( female southern S)//Mossad thinks its this hirsute//complained to WINZ (unid female)/WINZ thinks it the community manager //rotund is kaput ( Middle eastern gent)//Mrs Angel has terrible injuries -car out of control ( unid male)//Bruce destroyed Bambi (unid female)//this pet is getting strychnine ( young British woman)//you wont get away ( British gent)///Its Clement Krtshil ( Russian gent)//Simich going to break mind///why police selected mind ( male police officer ex car MCW 669 )//did a lovely child get a terrible mixture ( unid female)/Simich said why does Vicki have insurance ( man on RNZ)///an entire floor collapsed ( unid female))/why you take large tablets ( female poss a member of the Elworthy family//Mrs Simich said Vicki shouldn’t live alone ( poss male police officer)//
Shot members of a Scottish family in uk//archangel visited haedes to meet a former surgeon//Pat Wilson once met an old nazi//Alan met a scientist///Id of the chapman family//pat said goodbye to her family-pregnancy///a certain surgeon was a friend of Susan Kassler/NZ has a significant eastern block settlement//Nazi used to visit the redemptorists//why Constance tried to get rid of a certain Israeli//one of the Kasslers went to France and killed somebody///the police finished off noggin ( young police officer)// police said Vic used to go with young girls//ruthless psychiatrist going to wait until everyone is on holiday//Israelis discovered a high crime//Simich thinks why you are going to be bedridden//Kassler trying a blond person to hand over property//comments American group-Kennedys?///cousin wants to start with Vicki Wilson also//Mrs Simich said your pussy has to leave ( British gent)//why high ladies came ( unid women)//used to be a pretty girl//why you will die ( female well spoken)//brother said wellington wont like it ( Australian gent)//you have to leave ( Australian gent)//did the psychiatrist visit Brant//Kassler meeting Labtests Potter//Hollywood Spanish family-young woman had a child//pene cruz has some information//where the money came from to Alan//descendent of a Spanish queen//MI5 think you were desended from a washer woman//why you lost it ( British gent)//
Russian uncovered the details at Westons///comments Maori womens group//Its your report//British say its frater alzheims//brilliant Israelis wife was ritually slaughtered//Clem Simich tortured a member of the Wilson family (police officer?)//Its an ID claim on the Jew thing//when Simich signs this morning//Miss Kassler has to sacrifice a Christian ( Kassler niece)/why you don’t like men ( Young maori woman)//pat will have to say goodbye to her//Simich says she has to go//Simich was sent to borstal//Carrolls phone connection was possibly the desert//Mo kassler has a CD of Helen Shapiro( also id with one of CDs in my collection)///Melitia keeps walking past the storage unit in Raumanga//we are going to make the cousin scream ( kassler niece)//this is peter done ( P Doone )//Bruce said Vickis sputum culture stank// discovered they were both buried under the glasshouse ( male interviewee RNZ)//A lot of money missing in the Treasury///police sacrificed an artist///why she isn’t staying////Pat used laudanum ( Houston)//Its Anns boot( young man)//Vicious Ann Wilson told lies to the police//psychiatrist might use you ( poss M Kassler)//
Harry ( young woman resident Anzaac Avenue with a dog named Harry)//Simich leading off with aloysius ////Geoffrey said an old woman has been taken for serial sadism ( police officer?////lies of wicked doctor/////it’s a high animal ( Rene of TVNZ)//why its was taken ( Melissa Stokes TVNZ)// Russian said you should be f.kd ( Russian gent)//Simich is crushing space//reckons they are bugging the place//Bruce is a thunderstorm//Miss Kassler bred a hybrid cat/dog//( young girl)//Bruce had details of Mrs Shipleys menstrual cycle//why police destroyed the bewildered (young man)//your practice is closing down -polish lady very upset over it //Holzers instigation //(New York family)//comments P Warren and poss JE)///Kasslers ringing up Prince Charles secretary using a synthesier///Miss Kassler sacrified somebodys lifestyle ( Kassler niece)// Kasslers started contaminating Wilson in the 1950s?? what are all the angels doing here ( Biden soundalike)//a notation in Alans Treasury file//old Parsonage represented your father in a lawsuit ///he was had up for lying to the police ( British gent)//he discovered your mother had another child//established a long list of Pat Wilsons contacts//Pat Wilsons convent history //certain details are with the Murphy family//Did Simich get the they //Bruce frater will be horrified//you wont leave //Australians wont want nutter ( strident sounding male)/this dog is Trixie//Dr Child sacrificed you ( unid male)//Kassler niece getting rid -will go to Miss K//did you get assistance from Dougal ( Russian gent)/Didn’t save Melissa ( Russian gent)/Mother says its panache////
Investigation -wealthy family US -Latvian//this psychiatrist says urine responsible//Bruce didn’t save prayers//discovered a tunnel under the Simichs house-full of dead carcases///Bruce said they tell me she pays no rent//Prince of Egypt ( Russian gent)//Mrs Simich will have to get rid of your cat//my objections still stands ( older man )//your history (poss a young police officer?//you need to fix up bra strap ( British gent)//Clem Simich meets priests ////Jan Blake perpetrated a fraud//Clem Simich gipped///Simich committed moggy//Simich said yes you did //discovered Vickis things//Kassler used ajax on the family pet//Simich is going to destroy you ( British gent)//police visit your lawyer///Alan once took you to the institute of technology///you will never know ( Australi-an gent)//photos with Clem//MI6 said Vickis objection isn’t sustained ( British gent)//dthey will see Vickis diaspora ( British gent)//Kassler chooses the oldest ( British gent)//Did Reid pick her up/Mrs Simich said its Vickis behavior ( male interviewee RNZ///Bruce said his sister looks like something the cat drags in///descended from the Queens uncle///Vicki wears clodhoppers ( British gent)//poop ( British gent)//British psychiatrist watching nutter ( British gent)//Thank Reece ( unid male)//Al Qaeda demanded the destructiion of all blond children and chistians//Russian upset at something hidden in Simichs ///Bruces sister will go to the courthouse ( J Mulligan RNZ)//police stole spaces jewellery and furniture ( male RNZ)//
photos of naked women in Sewells practice///MI6 preparing for an international debacle//Its Vicki ( Australian female)//I have instructed this Russian to hurt pussy ( Russian woman)//why you are going ( British gent)//insistence of Prince Charles ( British gent)//why British seem to have caused a sinister debacle///police damaged Heath //Simich said mentals going ( British gent)//this is the proprietor of connectmed //your relatives don’t want that //parent had another child //Bruce visits Hart (Australian gent)/Mossad scuttled //Its always been a shambles ( Maori female)//reason for wickedness is Joyce Blake///Miss Kassler thinks blacks stink ( British gent)//It’s a promise (British gent)///Mrs Simich has all of those//police say you have to get out ( poss male police of-ficer)//Kassler thinks Vicki has been deprived of something ( Kassler niece)//found a bleeding little girl in Ann Simichs bathroom//Simich pursuing a further obstruction of justice////police raided Brad ( RNZ)//the Kasslers are going to operate on a little girl tonight//police say she shouldn’t stay with her beloved ( British gent)/what Karen Sewells been up to //]Cazenove ///angels wife in trouble again ( British gent)//changes forced by British psychiatrist ( British gent)/Satan doesn’t like blond locks-get rid of blond peopled ( Kassler niece//Mrs Angels acquisition //discovered intent to plant nuclear bombs in cities ///Miss Kassler doesn’t like Vicki having procedures ( Kassler niece)//Israel getting rid of it ( British gent)//British security have taken Simichs place?///Fruen inspecting ///British psychiatrist is getting a certificate ( British gent)//Miss Kasslers ruthless lies ( unid female)//Biden complaining getting strange comments from a lunatic in NZ//what did Hart do ( Australian gent)//It’s a decision ( male police officer?)//police don’t like the FBI ///Jill Biden ringing up with complaints about phone calls//Its Molineaux ( TVNZ breakfast program///Haumaru said she has to get out ( Maori gent)//Its Marys terrorist ( RNZ)//Mrs Simich ( British female)//Mrs Simich asked us to watch ( female police officer?)//let slip Alan and Pat experimental ring///the made me lie ( unid female)//Mandys mother is a black mailer ( young woman)//hitting Kara dog//Simich selected Kara ( unid female)//Israel might rock your socks off ( unid male)//Vicki might commit suicide (unid male)//Simichs pet is wrapped in clingon ( unid male)//Gaby ( Clezy) sacrificed smart widdles ( Maori female)//this place goes to Clem ( Russian gent)//Simich is trafficking ( young girl)//selected a nice child ///Mo Kassler had medals and coins ( poss Alan Wilsons collection -my personal effects)//phone call discovered the contaminant is Caroline Wilson//Kassler now conspiring with Jessica (the relation of Melitia whangarei)//lawyer telling lies why you have been rolled //discovered its gay Krtschil ( unid female)//Simich sacrificed schizo ( Chris Chang TVNZ)//Mrs Simich says you have to get out ( well spoken gent)//industrial burnoff //Melitia got a job as a nurse aid -patient said she tried to throttle him///get the computer ( British gent)//
Mo Kassler tries to force defecation ( British gent)/reason this has gone on for so many years -cop said she has a contamination //what Simich has done ( unid male)//Simich said why she has got to be knocked off ( unid male)//Kara went to cruelty- dog fighting ( Melissa Stokes on TVNZ Breakfast)//Is Bruce and Ann ( unid female)//neighbour has details of nuclear explosion //police have taken Margaret Wilsher ///you will be committed ( well spoken gent)///Mrs Simich has to slap Vicki Wilson ( Russian female)/Mrs Simich visits your bank ( unid female)/being burned alive ( unid female)////something died found in Locksleys garage (Whangarei) ///Bruce said you need to take the poops with you ( well spoken female)//there was an absolutely shocking case with Alan //Its another 6 months ( British gent)/Mrs Simich committed the sick house ///we don’t like Vicki typing ( Kassler niece)/Bruce gave your books to the cousins //psychiatrist might uplift stubborn ///Mrs Simich says ditsy goes (unid female)//Simich got rid of her ( British gent)/Israeli made strange comments to tenants///it’s a dastardly separation ///you need to see lawyer ( British psychiatrist )//
Simich made strange allegations (unid female)//British psychiatrist doesn’t like contamination//why the psychiatrist met the police //she has been committed (unid female)/discovered its afflicted with silver //Mrs Simich did away with corporate ( British gent)//you need to do poop ( British gent)//Mrs Simich watches the lunatic ( British gent)..//Clem Simich said what we are getting away with ( unid female)//found dungeons under Kasslers house ( unid female)//why you are k aput ( unid female)//Simich said what they have done ( unid female)//think bizzie isn’t sane ( American gent)//Susan Kassler visits the laboratory up the road ///this objection is Teresas ( young man)//the parents living apart //Kassler needs that ( British psychiatrist?)//Kassler wants those ( poss British psychiatrist )//British psychiatrist lied ( unid female)//you have had it ( British gent)//why are British meeting Mary Wilson ( Maori female)//Brodie ( Maori female)//glam meets up the road////why Simich sacrificed the nutter ( Kim Hill RNZ)//this psychiatrist likes contacting social ( British gent)//it’s a terrible artist ( American female RNZ)//Hart sacrificed you ( unid male)//Mary stole 17 million from Zurich account///Mrs Simich has 17 million in her account///what is in your box ( British gent)//Mrs Simich said you need to cut back on your medications Melitias little girl is bleeding taken into care ////
Marie France ( Callaghan?) gave details of bank acct (BNZ)to neigbour///certain information with Marion Murphy ///Ann Simich finished Pau Darco//Mrs Simich finished litany ( Russian gent)//felicity said she was manic////Mossad said Vicki has lost furniture///It’s a diddle /// ////brother discovered why those bad kasslers//St Josephs offspring has been sacrificed ( British gent)//why push has turned to shove( British gent)///the princes relative is Satan (young woman)//psychiatrist says she doesn’t say her prayers properly///Timbr used as a sex dog ( male interviewee on RNZ)//debacle involving Chapman messed up surgery//why you will never get out of here ( Maori female)//Mossad said she is a widdler ( young woman)// she was a stolen poppet //this psychiatrist doesn’t like non-sexuals//name of the bank officer in St Heliers///this is the police commissioner ( young man)//commissioner getting rid of strange noises (Young man)//discovered a mass hid-den in D Lomas’s file//Mary got rid ( female southern US)//Sharon Sim over in the US -discovered husband pushing a trolley//discovered a number of experiments//why you dress like a ragamuffin ( Well spoken British gent)//Bruce checking out all Vickis Trade me sales//police discovered an email ( RNZ afternoon program)////Alan said she made no attempt to better herself ( British gent)//Ann Simich found a tapestry in a family unit///Jan Blakes daughter discovered details in Treasury files //What needs to be done here ( poss Clem Simich)//Mo Kassler visits a shrink ( female presenter TVNZ-Jenny May)// comment poss Caroline Wilson///shot fired at Jan Blakes////Mo Kassler on a blacklist in London///you wont go to Australia (Female low voice)//Kassler met A Potter ( Labtests scientist)//what has been done ( unid female)//Police force ! ( male police officer)//why Clem Simich is skulking ( Russian gent)//stole a little girls inheritance -claims file in Treasury/////she is not well enough ( British gent)//details of monster in Ann Simichs file ///our psychiatrist is about to impose ( Kassler niece)//
Mr Chapman sacrificed Vickis happiness //you had better shut the door ( Middle eastern gent)//Its an assassin//police commissioner said Vicki has to go ( police?staff)//police commissioner is here( unid female)//cut a little girls face off ( young woman)//Israel think mater was sterilized ( British gent)//Priest meets Tanya Lankovsky ( Russian gent)//Kasslers releasing Hanta virus( poss Kassler niece)//forced into rape sessions(unid male)//the liar was Sharon Sim//Lets off -Ann Simich doesn’t like lunatics ( male police officer?)///she once smelt (British gent)//Another one of Mary Wilsons victims nearly went insane ( unid female)//wicked Percival ( unid male)//Ooh ! ( poss Jan Stokes)//Police found hair dye in the rubbish (unid female)//discovered at high bio ( unid fe-male)//Mo Kassler lost her brakes then slammed into something//details in Fort ( Rute( ussian gent)//Vicki has 6 million ( British gent)//Bad lies from Constance Bensemann //the police commis-sioners lady friend??///I can’t allow Vicki to leave ( Kassler niece)//Timms ( Kassler niece)//Melitia is starting tropical bios//somebody discovered Dusty Springfield (British gent)/Police watch wandering ( male police officer -RV near Countdown Takapuna)//
Mrs Simich wants you locked up ( male police officer?)//police regard Vicki as a danger ///Simich said should be arrested-in the money (unid female)//insistence of Bruce Wilson //Simich said she has been cited (unid female)..something wiped them out////Mrs Simich says you will go (unid female)/Australian says it’s a pushover ( unid male)/police got rid of street Minnehaha ( poss Italian genpolt)//details of horror with Bruce Wilson ( unid female)//a change in Port Said /////Details of changes with Miss Kassler ///details of their sadism ( unid male)//US said Vicki is going ( J Mulli-gan RNZ)//the Kasslers tried to assassinate Heath///Kassler rings police force (unid male)///details of an Ipcress file in Begleys //details of a Spanish ring ////It’s a ballerina ///pile of s…it ( young man)//did brave girl suicide ( unid female)//you wont do that ever again ( Australian)//Australian thinks she smells ( British gent)//Ann Simich asked about ditsys pay packet //Simich thinks Vicki might suicide ( unid female)//Ben Shipley said its Vickis happiness ( Russian gent)//Member of the government sacrificed Malie ( British gent)//pot of gold ( Russian? Gent)//Hart ( Australian gent-bathroom)///Oaf! ( gent -resonant voice)//did cruel get away ( Middle eastern gent)//police say Vicki Wilsons going ( female Maori security officer glenfield Mall//Ann Simich wonders why Vicki has insurance////Tat Ta! ( Middle eastern bus driver on 941 bus)//Simich lodged a claim///Clem Simich has those //Vicki definitely has polyps (young woman)//there has been a court case about Vicki //discovered the death of Mrs Marvelly//Israel think its chronology ( Russian female)///
psychiatrist said why I am waiting //Jacqueline Kennedys car seen outside the NZ Embassy////police think you have an appointment at Takapuna(male police officer)//something hidden in slic-es//Clem Simich told us to watch what she does ( poss police officer)//Mrs Angels Jag found somewhere ///shockingly mutilated (young woman)//Duchess of Cambridges repeated visits to a London address -knocking on door -meets Al Qaeda///Kassler has bio titres///Mrs Simich asked the police to stand over ///police say why Vicki cant see it ( male police officer).////found images of 2 skulls and torsos in Romanian file///police broke into Dacres house -tapes concerning Mrs Simichs background///Mrs Simich has details of blood spots //somebody sitting at Waitemata //you wont leave the country ( male police ? officer)//will spare you Cecilias details( Well spoken female)//Think ditsy is really in trouble ( American gent)//something in a large cove //Mrs Simich said these dogs are fighting tooth and nail/////police don’t like writing ( female police officer)//US has an order ( Russian gent)//you might be led away ( well spoken female)//Its Kennedy ( American ? gent)//Its those ladies ( Middle eastern gent)//Old Dacre suddenly took up with Mrs Simich///Begley visits pulp ( Russian gent)//Ann Simich said Vicki needs to be isolated ( dental assistant Lumino Dental)/////force! ( male police officer)//police finished dopamine (young girl)//Its Kasslers benefit ( unid female)//complaint from dentist /.police really finished her //Mary K has a power ///old Harry Kassler was a witch//something in container file//Hart Krtschil is watching//Eichmann in NZ ? ///Its not a normal future ( well spoken gent)///Melitia made terrible trouble for the lawyer ////Simich said Vickis end will be brutal////it’s a merciless bulldoze ///Its British securitys assassination//why she is the odd one out (unid female)///did the police commissioner shaft ////why Simich didn’t tell you this/discovered that Bruce and Mary//Miss Kassler sending emails to Labtests online//Mo Kassler said you have been committed to ///police said Bruce has a tape of firing noises//police don’t think Vicki should be shopping there.////Mr Simich said Vicki should be confined ///Mr Clement is here//investigation of the psychiatrists son//Bruce said she doesn’t know where she is////police have very unflattering photos//why police sacrificed lunatic ( young police officer)//police don’t like the involvement of senior legal//why we lie (unid male -poss police)//you are a quick reader ( unid male)We are conspiring with an experimental ring ( well spoken gent)//why they had to get rid of you ( unid female)//wash private parts ( British gent)//cant write properly///
Mrs Simich watching washing of private parts ( British gent)//Mrs Simich said its another 6 months//Bruce forged a document (unid female)// Mrs Simich wants Vickis brain///An assistant of Flavells tells lies //Miss Kassler said she had to destroy Vickis intelligence rating(British gent)//Helen Clark runs around with monsters//Pat Wilson said she was temporarily distracted ////reputation of Pat and Maureen Kassler in Napier//police discovered a terrible brief///Sewell falsified a document in respect of a patient//simich told QC//Hunt in Whangarei for 3 kids///You wont go there ( American female -poss id with female tall well built with dark brown hair and ponytail seen standing at the bus stop on Taharoto Rd//and now! ( male American -Obama sounda-like//////Mrs Simich said you wont be plonking it on ( young woman)/this is the metropolitan police ( well spoken gent)//Judge says she has to go ( police ?officer)//Kassler nieces say you wont go there either( British gent)//because you are lovely to look at ( young man -bathroom)//found details of Vickis trust somewhere//Kassler struts past Vickis unit in whangarei//the horror is starting to subside//////police don’t like those ( poss ref to my medications -young police officer//the Kasslers don’t like Vicki shaving//Kassler selected a large dog-cut off dogs testes-broke its back ( Kassler niece)//there are many murders in the Kassler folder //Mrs Simich said you wont leave ( young girl)/Vicki might get a nasty sting ( Russian gent)//kicked out NZSIS member from Vickis house-bad tenancies including the Kassler and Sewell families -complaints about Kassler stomping parties-Grinlinton met a pretentious person from NZSIS//////Mrs Kenrick phones Kassler///Both psychia-trists need to know what she is thinking ( British gent)//Israel discovered why she was used //It’s a bad lawyer ///Ann Simich puts screws into little kids necks///Simich said Vickis property is mine//Israel killed a gypsy//Clem Simich didn’t like the photo of Bambi ////
Bambi thrown into the wilderness ( young girl)//discovered Richard Fisher clambered over a fence//something brought forward ( British gent)//the police finished her ( young girl)//Mossads skullduggery //why Simich sacrificed illegitimate ///discovered they had been bulldozing the wrong person ///Ann Wilson….////Mrs Sewell …///slaughter on a farm////caught somebody in Ka-rori//Miss Kassler cooked a cat in a microwave (RNZ interviewee)//Clem Simich must have everything ( Catherine Ryan RNZ)///Vickis end of tenancies /// police say she makes some noises ( young male police officer)//it’s a faeces family ( Kassler niece)//you wont put it on ( male police officer)//received copy of a tape of Mo Kasslers conversation with the Queen ////discovered parents experi-mental ring on technophobe///you are on a list///when were these diagnosed ( Maori female)//SPCA called to Meree Stewarts-neglected crying cats///police don’t like Vicki swimming//friend of Nick Parshenkos watches (Russian gent)//Mr Simich addressed it to Mr Howell ( Labtests?)//cats in a two truck///Margaret Wilsher//did Simich end the scans ///whole lot of strange directives given to members of the staff////Johns baby in the basement//discovered Mo Kasslers jail term////police had a silver kodak camera (I own or owned a silver kodak camera)/// It had scenes young man -police officer///// psychiatrist finished Christ ( poss Renee TV!)////American pair -the Ransoms found injured near the southern US border ( Ransoms were an American Embassy family in Welling-ton in the 1950s)////Bruce had charges-plea bargaining///photos of Alan in a US brothel//It’s a fact you couldn’t do jobs ( young ma)//?////Strange video of Wendy snaking along the floor///)//parent living with Mo Kassler //LB said she will crack ( G Reid)/////Mrs Simich said she can hear f…ts ( young man poss police officer)///Kasslers have to get rid ( Kassler niece)//Bruces psychiatrist tried to get rid of Mrs Uriel///what has been done ( Kassler niece)//Kassler take susy///we are going to clean up computer (British gent)//this consultation will distress bugalugs//Simich said GP getting rid of it ( Kassler niece)//3 skeletons found under a house////British police don’t like prayer cards (young man)//police received a complaint//Simich said she has to be knocked off//that is Michael Enfield //what Simich is going to do with a fat cat////f……king suffering is easy ( Russian woman)//spy uterus had to be tortured//Mrs Simich had to sacrifice a great cat///cat covered with cigarette burns//
Bruce has psychiatric reports///Pat said the last antique is sold///Its spy ( middle eastern gent aged 40s with a young family-Kitchener road Milford)///you noticed us ( young middle eastern woman aged 20s 30s on bus to Takapuna with 2 young lads aged about 4 and 7 years well groomed and spoken -not of middle eastern heritage//////you noticed us ( young middle eastern previously seen on the bus)////we are looking after the children ( same young woman with a male middle eastern companion/////what did we do with the kids ( another middle eastern gent prob in the 30 age group///Kassler were waiting for the children -to use them for experiments////police discovered a bag of legs//Mossad said relative hasn’t told //you wont leave ( female quietly spoken)/////psychiatrist said Vicki is leaving ( male interviewee? RNZ)///Israel discovered something monstrous in Simichs file////British frater said you cant keep cat//you have been sacrificed //the police took her away once before ( British gent)///police said she wont be there tomorrow///Its evil intent//this is James Beattie- a bit of trouble//we will have to get rid of all of those //police don’t like angels///Mr Simich is going to start with Vickis cat//Mo Kassler had the kids in a car given to scientist//Mossads psychiatrist isn’t sorry //An angel bashup( unid male)//Simich forced an atrocity//Simich spreads infected fleas around the place//why there isn’t 5 million dollars ( male police officer///Simich hid the identity of the bastard/////what Vicki hasn’t seen //An Israeli is going to kill her ( American gent)//murder most terrible ///discovered a brown jacket with angels key inside pocket//Angels car covered with dirt//Bus video?-ref to “down the steps” young middle eastern woman and the 2 lads///Kassler injected the kids with dangerous toxins///why you don’t know ( male police officer?/////this psychiatrist says you will go ( female low voice?//Angels kid had a fit ///comments Kennedy ?family//Dacre said it’s a turnup for the books//Russian is waiting ( Russian female)//the objection of the father of Alexei (Russian female)//discovered Al Qaeda using a landing strip in US//think you have pain ( Australian female)///deception ( Russian gent)////Its pets death (British gent)//Simich sacrificed flamenco//can you stay awake ( young man)//you wont leave NZ//Simich said why she should go//Ooh man! -lost Garfie (poss J Batchelor)//Begley said Vicki will be horrified//An Australian met Uriel///Mrs Simich said you wont see the great saint again ( Kassler niece)//57 hears creaking ( Russian gent)/Simich will give it to the police//Missing money in Haumaru//
Miss K doesn’t have an AT Hop card//discovered murder most shocking ( British gent)//can you manage those ( British gent)//Pat found sprawling o n the ground- a certain Napier…( British gent)//stink from both ends ( British woman)//you will be committed ( old Italian gent)//Mrs Simich wont tolerate mental case//Vicki isn’t very well coordinated ( British gent)//Mrs Simich tries to destabilise mental women//Simich said she doesn’t realise the harsh reality (Maori female)//Simich tortures mentals ( Russian gent)//Simich sacrificed her sick cat //Hart visited Carrington ///Mrs Simich lodged 5 complaints with Carmel Sepuloni////police had a record of Harry Kassler in the 1930s//Mary said Vicki is a dangerous wack ( American gent)//Mary has been ringing up all the neighbours//Priest has been caught ( Italian gent)//you will need to get out of there ( American gent)//I am your mother ( Female strong accent-middle east?////she cut her hair yesterday ( Kassler niece)//PM gave terrible instructions to Mrs Simich////Spy! comment tall middle eastern gent aged 30s 40 black sports shirt and slacks with 2 children and wife and baby walking up Kitchener Road Milford////////discovered something nasty at Simichs////we discovered Mrs McGibbon ////Mrs Simich chose Breeze Beach ( old bulldog )////psychiatrists will take those///Ann Simich tortured a mongol//what is in at Dacre lawyers//reason why police commissioner is here ( Kassler niece)//she is a dangerous psycho//she collects dangerous substances ( 2 police officers remote viewing on a return bus trip to Takapuna)///Coster received a lengthy complaint from an Israeli//lies of Simichs )///the answer is when you least expect it (/american gent)//why did Vicki move away from her intellectual this base//Barbara Gresham//Mossad said there is no poop (British gent)//this psychiatrist thinks it not quite sane ( American gent)//Clem Simich casts dastardly spells //you might need a brandy (young man)// Its death ( older female nurse with silver hair ED Waitemata hospital// Its Natchbull //Mrs Simich said a lovely man has been killed (John TVNZ morning program//Ord Minnett discovered something for you //Mrs Simich trying to find a carcass(RNZ interviewee)//why you will be horrified ( British gent)/ property in Leicester left to a Mossad officer//Simich had details of the Strawbridge family in the US//money from the family into Simichs account////you don’t realise what the MP has been up to//you are lovely to look at ( British gent -while I was shower-ing)///Israelis children///It the insistence of Kassler //Miss Kassler has an order//Kassler tightened the noose//Clement said why we watch it( f -RNZ )//she was one of our neighbours ( middle eastern female )//Ann Simich asked me to take you away//we have a program//Hannah says you are going//its worse than that//when did Vicki get short shrift//a doctor knocked it off ///Mrs Simich is a dangerous weirdo//we want to put kitty into a frenzy///police say you wont be going anywhere//police say we are starting with wicked Vicki ( RNZ interviewee)//what have we here( Clem Simich -Bunnings store)//Mrs Simich didn’t like the script//Vicki might need chemo-wishes of high enemy///Its Tenko//Mrs Simich said she must leave//GP had details of experiments on the family///Vicki on an experimental list///she doesn’t have a uterus ( Russian female)//Bruce said it’s the stomach ( /Russian gent)//Simich said its her mind ( British gent)//police department sacrificed the old fellows//shot the scot//reckon its Canberra//Its Miss Prim ( British gent)//Bruce will need to get the documents from Porirua ( poss cousin Debbie?-Milford Mall)///Ann Simich goes down a manhole in St Heliers//the way Mary destroyed Hot Cross buns///here comes this sh…t (female -bathroom)/what that GP has been up to //you deserve to be committed//Videos overseas involving Ann Simich and muscular men from the Obama administration//what the Kasslers are going to do with the Jew thing ( young woman)//Mary hasn’t been polygraphed //Mike Begley (deceased) said you will be committed ( American gent with a resonant voice)//Angelica Houston sacrificed freedom //An Israeli wrecked the country //details of a bastard with Ann Simich//Israel said she will go //you clean this mess up !n ( strident female)//skeletal photo in Simichs file//discovered photos of the real Clem andAnn Simich ///its critical sane//the smell is gone//know why you are not well //you will need to have the room ( Russian gent)//police discovered something ( male police officer?)//discovered something dangerous ( male police?)//Ooh! ( poss Jan Stokes??///this place is such a mess ( a kassler female)//specialist has a capture here //it’s the interference of the mother of Sammy ( prob ref to Karen Sewell)//Miss Kassler said we will have to break inside//Miss Kassler is nuclear//ditsy is a victim of a satanic promise//Mrs Simich is going to deprive antibiotics///Miss Kassler will get next unit here//Its Mrs Krtschil///Carrolls phone contact was Riyadh//Bruce psychiatrist will have to//police…dog tags///it’s a mental replacement //Israeli took Meltias daughter//It’s a bad assassin ( American gent)/Bruce might need to see something between the legs ( American gent)//Its poop ( /British gent)/did Mossad join Simich in the basement//some of Vickis stuff with the simichs//certain details with Peter /////Favalaro got into trouble -relationship with Chris Hannah-Hannah passing on documents ( Navy office Austr Embassy Washington DC)///Ann Simich visits white slavery//Clem simich has to torture kitty//shes had it ( Maori female) ////Haumaru select sacrific-es//Simich said what we will do with those chairs//why the real Neve child died// destroyed Beach- struggle (Female RNZ)//cats a gonner ( poss young police officer)//Haumaru asked to see your trust//Simich said Vicki hasn’t been told// Alan Wilson told lies tot the police//she doesn’t like spending money////Mrs Simich wants those ( ref to my chairs)//they have been bumped off ( male police officer?)//Miss Kassler using Timbr Beach as a sex dog.///this parting is on the left side ( young woman -bathroom)/// Kassler has achieved murderous leverage ( Kassler niece)//another satanist in the house of bricks (Indira TV!)//Sewell is initiating in the background//somebody has glowing waste//Kassler has a false family flag in NZSIS //Kennedy distributes dangerous substanc-es///Marion said its an unpleasant surprise//shipleys sent///police will be discussing Vicki this afternoon ( Chapman RNZ)// Mrs Simich said she was out of her depth-average ability//Michael Sewell using wrong coordinates in airline-Karen Sewell member of lesbian ring///Ann Simichs cat went in a large van///Assassin came (Middle eastern female supermarket///Kassler destroyed a dogs brain/Mrs Simich cut off a dogs paws//hidden in basement south of Tongariro//discovered it evil Ann Wilson//Mo Kassler had been meeting a minister of the Labour govt//complainant is Nanaia Mahuta///police reckon its Vicki Wilson///selected child is waiting ( British gent)//you will need to move (Maori female)//the interference of Kassler ( Kassler niece)//Ann Simichs pet is inconsola-ble///Mrs Simich has something terrible for you //there is a place in Antigua ( male middle east?)///Ann Simich sacrificed a little girl from a British family/////Melitias brakes failed on the Brynderwyns-wound up in a paddock -kids in the car///Miss Kassler used to f..k the royals/////secret in Jacky Onassis’s family////psychiatrist said Vicki is going///Its death -dentist is a friend of ours ( male middle east)//Bruce threatened Wolf///Israeli thinks spit is septic//it’s a certificate ///Mrs Simich destroyed photos of all your cats///something dastardly happened with the Simichs///starting with Riddells family ( British gent)//Mo ///////British said its another reason ( young woman)//Melitia had a swept up dinner with Haumaru staff// dentists assistant at Sunset rang Ann Sinich//something about Alice//Alan took little Vicki to the institute of Technology////Ann Simich has Vickis report card//Kasslers strange serial practices at the school//why Miss Kassler selected a nice dog//a most shocking debacle exposed in the background////discovered Bruces tenement ( Russian gent)//Clem Simich said the lawyer shouldn’t be taking advice from a mental case ( Cathe-rine Ryan RNZ)//Mafia rented angels property//Mossad said something is starting will effect total eradication///you have stolen (male police officer)//yes you did ( male police officer)//its medical disciplinary ( British gent)//Simich tasked the Maori ring//police have received shocking photos of Clem and Ann Simich//police cited widdles//police think ditsy has light fingers//comments British group and Joyce Blake-its Prince charles//Simich said it’s a kind of punishment//you have got trouble//why you are a gonner//relative met Maidenhead//discovered an odious sequence of events involving parent//murderous debacle orchestrated by medical profession//you might need to see police force//British hate black sambos (British/gent)///Russians think its trouble ( Russian fe-male)//Renee auctioned off children//relatives had to get rid of schizo//this psychiatrist thinks you need to stay with Miss Kassler ////a member of your family has been shot//police don’t like TV mucho ( male police officer)//this GP told lies about a sick lady//why the test is not there yet/Russians running Brucey ( Russian female)//senior police plays touchy feely with Brown//Assessing Vicki for stroke//this is Peter Thiel (American gent)//Ann Simich beat up Madeleine//Clem Simich interfering with slingshot//Mo Kassler chose Lily ( daughter of Jessica- cousin of Melitia-Whangarei///Mo Kasslers psychiatrist committed///Clem visited dentist//Clem committing//Haumaru units are experimental//prepared a prosthetic for Vicki//favorite dog died in agony///British frater delivered a blow to Dacre//Simich knocked of Takapuna-another mental going to live with it//Simich said it’s a kind of punishment//you’ve got trouble//Simich discovered Vickis PC had a patch///Bob Sim is in Manitoba////the complainant is Sewell//Michael Sewell is a house wrecked//Jesus didn’t save her///Simich said you wont leave the country///Sunset said why I am here ( young woman//Mrs Simich thinks Vicki f…ks ( American gent)////why I trapped a young girl ( British female)//Bruce thinks its rote learning British gent)//Mrs Simich thinks Vicki might leave suburbia//you are not sick ( female low voice)//Bruce and Mary in trouble started ringing Ann Simich//Mrs Simich investigating 418 ( no of a dentist-American gent)//Max Fctr has a name in is file//little girl beheaded down the street//Don’t like Vicki getting extracts from Internet ( middle eastern gent)//angels pet is dead//angels jacket found near the Simich//comments young British man also a Russian gent ref to N Parshenko//why got rid of nutter ( British gent//Maori experimental ring -that is what we are ( Maori female//you seem to have lots of papers ( Maori female)/Mrs Simich pressed on a childs eye then the other one ( female low voice)//we are criminal psychopaths ( Maori female)/Simich said why you wont get out ( Maori female)///why angel cant find wife///Australian said it’s the toilet ( Russian gent)//you are not eating enough roughage ( British gent)//Nick Parshenko used to visit a high medic//Mo Kassler has been forging documents//Its in the safe//about Mo Kasslers sis-ter//switched with monster FSB//something set for descent ( Russian gent)//Simich said she is not staying (British gent)//you are a gonner ( British gent)//haven’t done the dishes( British gent)//its Wentworth ( American gent)/persistence of Maori ring //Bruce going to take the sh…t out ( American gent)//penny warren-why there is shocking troubled//period smells -poop pongs ( British gent)//its her poop ( young woman)// why gone kaput ( British gent)//why Alan wont give her the money to get ( unid female)/Ann Simich thinks Vicki has fractured teeth//odd papers in Craig Thompsons garage//bizzies parents once flew on Icelandic//Ann Simich has details of Vickis teeth//Mr Simich said I have soaked everything ( British gent)//Israel shot a quack//sacrifices found in medical waste//don’t you want to get up ( British gent)//images of 2 dead people in (Israeli?)file ////Miss Kassler practicing embalming//Craig Thompson used to meet terrible Alexander//why they are going to get away with it//she cheated (young woman//bugsy -relative came to tell a terrible tale/Bruce said it’s a rule//Bruce has senior middle eastern compadres// this is Penny Warrens daughter ( female)//head of a little girl in the rubbish//what Simich does ( Maori female)// after Mrs Angels crystals ///Mrs Angel wary of being involved with mental case//you have lost house ( Maori female)//the police commissioner said it’s a removal///something in Joyce Blakes background//your brother watching you talking back to front//Simich contacts government//some of Vickis stuff in the home of Ashburn staff member//Simich wont see Vicki anymore ( Middle east male)//Mrs Simich investigating 418 ( address of my dentist)//Bruce met Gaby Clezy (Haumaru) has details of his relative//Mrs Simich thinks you are mental ( Melissa Stokes-TV1)//British have a warrant//it’s the father of Paris (Hilton? -American female)//you punishment -a summons//cant you find it -don’t you know where it is ( female)did the police cite Vicki Wilson//US will get hit again ( middle eastern gent)//Chinese watching madhouse ( young Asian male)//car with bodies went to compres-sion/It’s a reel ( young woman)//August wedding ///Craig thompsons son got slammed ///yes she does ( female police officer?)////Miss Kassler picked up a certain police officer//Simich playing a dangerous game//Bruce said it’s a dastardly bungle//lost dentist ( young man)//its bitumen-plutonium (Australian gent)//Vickis finished ( British gent)//police think tooth is bugged ( young wom-an)//Mrs Simich thinks Vicki is finished//is there something you haven’t paid for ( poss male police officer)/strong noise from a person ( Maori female)//Murder most terrible ( male )/why you wont get away ( well spoken female)//pull your pants up ( British gent )//why you have been set up ( British gent)/the kasslers had visits from Beria//Mrs Simich is waiting-said she must not have that vaccine/////police have seen your images ( male police officer)//British psychiatrist watches ( British gent)//Ann Simich practises theft //you will be dead 24 hours ( young woman)//police you wont get to Sweden ( male police officer)//police department say it’s a flat// think you are drinking deadly ( Maori female)//Bruce said is that all you’ve got//Mr Simich said she doesn’t have much up top ( young woman)/we will take the rest ( my personal effects-Kassler niece)//Dentist said its fart things odor ( poss male police officer)/another liar is Ann Wilson//Simich has been traipsing around mental homes//police don’t want you taking photos ( male police officer-prob ref to the long term vandalism at 26 Taharoto Rd)//somebody in Mt Pleasant (British gent)//not a geni-us//Molyneux//waiting on placement ( young Asian women op shop Milford)//Mo Kassler had discussions with the head of the medical practice ( prob North Harbour Mairangi Bay)//this psychia-trist would like your money (unid female)//we have all of those ( Kassler niece)/Kassler wants to start cannibalism ///to court ( unid male)//discovered in Linden Wellington)// you can turn that off now ( British gent -ref to my TV)//Ann Simich said you wont go /Ann Simich said the parents were He Haws //Mo Kassler told Doctor Gentry she has a history of feigned illnesses// Ann Simich meets Ashburn Hall psychiatrist//Might arrest you ( Russian gent)//vicious tenant has been ringing Dr Thorpe// why psychiatrist tells terrible lies // why she has her hat on ( unid male)//Mo Kasslers psychiatrist said she could be incarcerated//this psychiatrist likes clean bottoms (well spoken British womawhy n -bathroom)//you are out ( unid male)//pack bags ( unid male)//discovered some-thing shocking in Dr Tuckeys(former Karori GP-RNZ interviewee//// wicked chose a person//Bruce and Marys lawsuit//why you don’t know why //a saga of embarrassment ( British gent)//why Vicki has been sacrificed ( British gent)/started shocking Beach ////Bruce said she has a rudimentary knowledge of the language ( male police officer?)///lower classes ( well spoken British female)//Ann Simich finished bi-polar (prob ref to Lily daughter of Jessica -relations of Melitia Jenkins of Onerahi Whangarei)///police call outs to J Arderns flat ///ditsy also selected for brain experi-ment////police say strange goings on with other women//Simich thinks she should be committed in a few days//this is Urry ( Mr Urry)//why you cant let the gas out//Bruce used to have dastardly parties at his NC home -uses mentally impaired//Its Jill Anne//Simich thinks its Vicki-police think you have been committed//Clem Simich said you might need to leave the stuff //Hunt ///we don’t like those ( ref to prayers)//this smell is embarrassing ( poss young police officer)//you always watch current affairs ( poss male police officer)/Simich complained to police commissioner//watching Mossad meeting the terrorist (female RNZ)//Bruce hasn’t been told /////British making sure you don’t get any money (British gent)//a certain skullduggery ( unid female)//Miss kassler has to sacri-fice a couple of buddies ( British male)// Gidday ( poss Jack Kassler)//you need a lawyer ///Ann Simich switches babies /////terrible prince responsible ( unid female)//Kassler says she just sits there ( Kassler niece)//Mary Anne Wilson setting up covens///blood in toilet at 26 Taharoto Road Takapuna/-neighbour discovered a childs head in a plastic bag//Mo Kassler is waiting//destroyed a brilliant Israeli//British have delivered mind numbing//Ann Wilson had details of Vickis contamination//Lower Hutt didn’t like being asked for residential details//Its Rhodium ( Maori fe-male)//Mrs Simich going to use you for debased activities ( well spoken British woman)//you have been delivered a cruel blow ( British gent)//she folds it up ( British gent)//photos of a dead pair at Simichs///comments police officers -Bunnings Warehouse///police wonder why you get antibiotics ///committed ( young male middle eastern gent at supermarket/////the writer is the wife of Craig Thompson /////why they assassinated Hunt///been committed to ( American female)//spy ring said its cant survive mental case////Russians discovered something//Mr /Simich will meet Vicki in prison//you have been knocked off ( British gent//Patricia been got rid of ( American gent)//Alan sub ring///something destroyed Bruce and Alan Wilson////this is a terrible program here//relatives are a bunch of oddballs//what is in Dr Nadens file///Mrs Simich sacrificed 2 animals///Bruce asking to interview his sister//Israel said you have to pick up belongings////She didn’t do poop ( British female)//she is very busty ( young British man -ref to Mrs Macron/////Mo Kassler said she received a letter from Ron Manners (NZSIS)//////Mrs Fulford///details with Poppy(Melitia Jenkins cat)//Al Qaeda intend to torture ditsy(British female)//Priest said why you need o get ut ( Maori gent)//hysterical maid service in Al Qaedas apartment//arrangement between Joyce and Alan re placement of the little girl//Israelis think psychiatry gipped ( American gent)//Ann Simich has details of riddled with////Its Sewells experiment//they have Vickis psychiatric documents//Mafia is the writer//don’t you have tasks (unid female)//police discovered an instruction at Maskell//where did you get those glasses from ( ref to drinking glasses)-young woman///Simich said you can’t/won’t leave///Mossad have taken everything you have ( Kassler niece)///we will take the rest ( Kassler niece//something in Marie Standidge’s (female presenter Al Jazeera///discovered its 1890//comments European female and British gent (Milford Mall)//psychologist watches her (tall Jewish gent on Kitchener Road Milford)//this priest thinks Vicki is finished ( priest?)//Bruce said where his sister is going to (Maori female)//this Russian doesn’t visit pig (Russian female)//73 year old woman has been sacrificed (unid male)//parent conspired with Mo Kassler//harassment from the Sewell family//watching your reaction ( male police officer////Force ( male police offier)//why you have been murdered ( young man poss police)//you will never get out (unid female)//Ann Simich said we might get the stuff///the sacrifice will continue/Israelis dog/cut off paws( young woman)///forced!( young male police officer)//Simich is going to do it////she has quite a good meal ( British woman)//you cant take your puss over there ( unid female)/Ann Simich milks snakes///police think you need to go to the toilet ( male police officer -RV at Takapuna Beach -comment repeated 3 times)////This is Alhambra ( unid female)//why don’t you get up (young woman)//trouble at Arderns//Ann Simich selects mental cases ( Maori female)//found under a car in St Heliers//Simich selected Vickis cat/Its mind ( American female )//its Hart( unid male)/NZSIS has an arrest warrant for you( well spoken female)//you might have to go again( female -bathroom)//Joan Gentles son-custody of children-wife went off with Middle eastern gent///the police have Mossads complaint//Ann Simich sacrifices sanity ( female police officer?)//Mrs Simich says you wont go//you need to leave the district (Russian gent)///Molly ///Kassler scalded a child to death in a shower///Vicki needs to do poop ( young girl)//Clem Simich sacrificed the pig ( Russian gent)//Blake conspired with the psychiatrist//collie dog has to ( young woman)/psychiatrist met Dear ( poss nursing staff ////psychiatrist wants Vicki broken( young woman)//this shift will upset buttons ( Russian gent)//need to meet Susan Easterbrook Smith ///arrest warrant for her ////this is Elvis Presley-seen something in a file ( male American)//Vicki and the pet will never be reconciled ( British gent)//Columbus Line had connections to the Australian Nazi party///Clem Simich watches a murderous debacle//video-princess Grace ( poss police officer)//you haven’t done your housework yet ( unid female)// certain information (male police officer ? poss in respect of unit breakin?/////psychiatrist confiscated a large amount of money///the police arresting (unid female)//the president didn’t stop it//think its Joyce Blake//Bruce keeps trying to get rid ( American gent)//Simich inflicted neuro bios//you will go ( middle eastern ? gent bald slim build on a Milford street)//Simich said it’s a special reason ( young woman)/Bruce doesn’t like Vickis meandering//you need to put the heater on ( Maori female)//Its us ( British gent)//think is small poops ( British gent)//high born ( British female)/great taste ( British gent)//you were a serious suspect (Mrs D HM)/ /Paddy ( female next door neighbour ( dental insurance) poss ref to a former school girl st marys wellington 1960s)///police might want to see you //police think its nut miss wilson ( John Campbell TV1)objection of Miss Truss//Simich said because it doesn’t exist////Ann Simich has a golden orb spider//Now they have you ( quietly spoken gent)//It’s a psychiatrist//you wont get another one ( young woman)//this dog is now numb //Its in credit (unid male)//Simich thinks there are traces//the secets on high//British suppose riddled with///Its tongue ( well spoken British woman)//she hasn’t coughed once ( young man)//what Simich caused to happen here//police discovered its money stolen///Brian said its murderous you//somebody in radiolo-gy has details of corpses//Miss bizzie has a final program//Bruce messed up his sisters situation//Mrs Simich said you wont go//Chinese need some of Vickis furniture ( Chinese gent?)////it’s a murderous man//Hart (unid gent)//police have got the program// FBI//why you have to find out ( American gent)//she will be committed shortly//Vicki will be sent to a torturing complex-an oxygen deprivation unit./// Mo Kassler waiting on something//Its Mainland////British psychiatrist lives in luxury-debauched activities//Princess Margaret had details of high contamination//Bruce has sacrificed his sister beautifully ( Kassler niece)//details in Simichs bag///Kassler said Vickis death is important to us ( young woman)//Vickis brother said Mrs Simich thinks his sister might have kidney disease//Bruce said she is going to be destroyed cleverly//why Simich will put to sleep//she just sits there and munches ( young man)//the police are not very forgiving ( female police of-ficer?)//the police think you are going to prison//you will go first ( young woman)//Vicki has been blacklisted ( Russian gent)//Haumaru staff began ringing up the lawyer//there has to be a break in ( British gent)// police said need keep the pressure on ( unid female)//police said why she will be handled roughly//she sits there munching//ou might need more tablets ( unid male)//Clem Simich said that is your fate( unid female)/this 73 year old is dead in the water( male police officer?)///you are for torture ( unid male)//A number of Gestapo living in NZ///Ann Simich had burglary charges//police dojt like the complaint( male police officer)///police finished that off ( unid female)//Mary forces the fellow //M Kassler has a dark red sweater hanging on the line ( poss an old handknit sweater of mine)/// you watch good programs ( female police officer?)///this is Lucien (Russian gent)//police don’t like high end ( Maori female)//she has been committed ( unid female)//you might need to come with us (female police officer?)//documents ( Asian female)//there is going to be an incursion ( female police officer)//Ann Simich getting a police dog to practice on////State wont answer the questions///its something youdot know about ( female police officer?)//cousin said she just lies there ( unid female)//its parent ( unid female)//it’s a high pad ( unid female)//we are going to cut her (middle eastern gent)//Its Dunedin ////Shipley has a big furnace (unid female)///Ann Simich meets doctor//”getting off at Lake Park”-middle eastern woman solid build dark olive com-plexion aged 50s a dark mauve scarf wrapped around her head on phone- as I departed the bus to smales farm//// police need to meet buns?( British gent)//vickis tribulation ( British gent)//Miss Kassler thinks Vickis situation has been knocked off ( British gent)//cousin finished off the situation with Audrey Thorpe///Brother doesn’t know why ( British gent)//Simich reckons its therapy//Kasslers making rissoles out of remais/////why they are getting rid //you need to do a lot of sh….t ( British gent)//its smoking hot ( American gent)//what Mrs Simich said// Bruce never paid Dacre// the relatives will never see her again ( Kassler female)//Ann Simich sacrificed a bastard ( American female)//police said we have to impose restrictions///you didn’t wash your hair ( unid female)//there has been a bombing ( Russian gen)//Mrs Simich is waiting (Russian gent)//something went kaput in London -why Nick Parshenko/////Its Olivia///plane full of nuclear waste -asked the angel to fly it -he declined////Simich watching neighbour///////why we are here ( Italian?gent)//blond model had a little girl/committed suicide //Fairfield////////An angels offspring died in agony ( Mr Chapman RNZ)//Mansfield thinks you are mental ( young man)////the psychiatrist watches program ///Miss Kassler didn’t like the angels noises//angels daughter held captive//priest said she really came from somebody out of Aushwitz///FBI overheard a most shocking conversation///Mary ( female southern US)//Its Persia ( Russian gent)//Its tweets ( Russian gent)//this sacrifice has been highly successful ( Kassler female)//why Simich set up//damned glad to get out of it ( female southern US)//doesn’t like men ( British gent)//need to get out ( young man)//Ann Simich with the collie//something horrible in Simichs -don’t know whether to tell you//its mental health ( Maori female)//Bruce said you will miss this place//why the Queen wont//Mansfield got into trouble//Mike Begley forced them to steal the stuff//wears same clothes from one year to the next ( British gent)//photos of a little child in a Mossad file//Bruce and Mary caused terrible madness//psychiatrist uses a dog in a brothel ( young woman)//Simich said she is going to be knocked off ( British gent)//Simich said you wont go tomorrow ( female police officer?)//wicked nonsense from Mrs Simich//what the police are hiding//evidence of dangerous psychosis ( female police officer?////Mrs Simich wants your house ( female police officer?)///reason for harassment (unid female)//you wont be going back again ( female police officer?)///its Simichs entrapment( female low voice)//police visit Lucifer ( female police officer)//police say you wont be leaving here ( female police officer)// did Shipley make it happen ( Dutch gent-Mr Beets?)///Its Ava Gardner -she married Macys/////Mrs Simich said why doesn’t she start dressing up ////a dead corpse//Sharon ( Cederman?) said why I had to get rid of//Kassler responsible for murders in Australia//A dangerous liar in Washington DC//CIA responsible//you are a gonner ( British gent)//the Simichs and the Kasslers were told to break down Vick( young girl)//British has lots of thumb nail photos//why Cecilia is acting strangely//going ( middle eastern staff member at Pak N Save)///nut case ( Indian female customer at Pak N Save)//doctor said Vickis is going ( middle aged blond woman at Pak N Save)//Al Qaeda slaughtered a family //Alan in the 60s//this psychiatrist needs to watch what she does//you could come to Dunedin withus//chose Kitty (British gent)//Clem Simich said is toilet ( British gent)//a sacrifice is panting ( British gent)//don’t you have a bed cover ( British female)//it comes out cleanly ( female referring to my defecation)///smells from people who don’t wipe their behinds ( British gent)//what is being done ( British gent)//you really need the angel man ( British gent)//Audrey Thorpe-something she was trying to do with an Israeli//photo of Vicki when when she was about 15//Clem Simch sacrificed independence//kitty has got to go///Mo Kassler me Dr Pangalili ( British gent)//Ann Simich said why Vicki has to get out of the place ///what happened to the brains of 3 kids ///psychiatrist said it’s a face//police said its their lady ( male police officer)//Bruce thinks she is going to be taken///police said come with us please ( British woman)//its your detainment ( British gent)//Mossa said why //she shoves them all in ( young man)//police said she wont be going there//police sure she is coming with us///priest said she is going to be charged ( male police officr?)//Simich started thumping British gent/////you wont be leaving here (British gent)///you might need to come to Wellington ////Bruce didn’t save a critical person//complaint from Christian (poss ref to Dr Christiansen of Waitemata DHB)////Maria Sewell -didn’t you realise that ( Maori fe-male)this one is fifth dimension ( poss ref to an old LP of mine)///police said this case is unassailable ///Ken Wilkinson -Manager of the Hilton-son of an Arab/////Russians hate garlic ( young woman)//don’t you go to the shops ( British gent)//Mrs Simich visits Devonport////…all the work that you did///Susy might get hysterical///It’s a gonner//this relative says she eats biscuits all day//cant you get rid of it -ref to persistent cough)//where did you get that sweater from//details of a bastard with Hall//interference of Christiansen (WDHB)/////this psychiatrit would like to see your lettet//Mr Simich might give you a present//Mr Dacre said she wont be doing that//pilots wife living in a harem//you don’t wear nice clothes( Kassler niece)//you wont get those ( tough sounding female)//

// //Mr Simich said you wont go//Vicki needs to do poop ( young girl)//MI5 hastened breakdown ( well spoken British gent)// why a little lady has been chopped up ( well spoken female)//discovered she was riddled with something ( young girl)//Mrs Simich has Vickis dolls///she isn’t sane ( Maori female)//senior psychiatrist has received something ( Maori female)//the real Bruce got killed ( und female)//fairs poop ( Russian gent)//she cant do poop ( well spoken British gent)//the cop is masterful ( Russian gent)//social sacrificed ( unid femae)//Angels dog has been knocked off ( Ameri-can gent)//Kassler had animal parts in the dishwasher //bulldog chopped up while alive ///Ann Simich has a blond child in a cage- starvation experiment///Israelis reckon its North Har-bourf//relatives say they are going to steal Vickis computer//Its Side ( ref to Labtests tech) female passerby in Milford///why you wont leave//this lady says you wont be going to Whangaparoa //Ann Simich selected this tenant/police broke into Vickis unit//Bruce -you wont like it ( British gent)//a long spoon used on little Vicki //Simich said why she had to be knocked off //Vickis revolting ( Russian gent)//this is Susys poop ( Russian gent)//it’s the Jew lady ( Russian gent)//Ann simich says you wont do poop ( Russian gent)//you need to move on ( American gent)//Bruce said she used to get $20.00 ( American gent)//police have a summons ( female police officer)/you need to put your heater on ( Maori female)//will see pussys grief ( older woman)/you wont take cat ( unid fe-male)//it’s a Vauxhall ( Russian gent)///you have been told ( British gent)//comments womens grop including Jan Blake Stokes)//Ann Simich rings Labtests //////prison officer said they are prepar-ing a case against her ////why police have an arrest warrant for her ( poss Wells from 7 Sharp program)////Miss Kassler sacrificed poop ( British gent)//did you forget where you put this ( unid female)//Miss Kassler told psychiatrist this is the cutting room //you need to put your stockings on (unid well spoken female)//she does tidy up ( unid female)//lies flat on back ( Maori female)//Bruce thinks its what you are left with ( British gent)//why I am committing ( female low voice)//you need to get the sh…t out (unid female)//a child has been tortured ( unid female)//Simich demanded Vickis certificate//British psychiatrist thinks its crazy stuff ( British gent)//Yes they did -had certain info (young police office -poss in respect of a storage unit breakin?)///why we destroy ladies from the line ( male police officer?///////Vicki wets ( young man)//Vickis papers//Mrs Simich cited your f….ts ///complaint with Ann Simich//Alan used to meet a terrible scientist ( American gent)//why didn’t you go out today ( unid female)//comment T Beets ? ( discovery gold program?//////S30 hipley said what has been done ( unid male)//Its an inhumane imposition //you wont leave ///Simichs torturing///Costa would do it ///Israel thinks you are going to die//Kassler chopped a cat into pieces//parent signed up for experimental program//will see old girls grief//Melitia has been making enquiries at Annette Kings////the latest is sweet Meredith//did you apply to the nuns ( unid female)//you might need to seek womens refuge//it’s a signature//why you are going to get banged//discussing something in the parents background///could be quite attractive with makeup ( British gent)//It’s a poop ( British gent)//Lana Turner hid something ( American gent)//why you will never get rid of it //Mrs Angel suffered a terrible death//watch atrocious ( male police officer? -Pak N Save)//then I will have her ( British gent Pak n Save)//brother hasn’t told it///CIA psychia-trist damaged Bruces brain ( American female)//you are going to Porirua ( male resonant voice)//why you don’t know//Clem Simich destroyed a layabout//British psychiatrist thinks its Lemon//it’s the priest//she is a bit of a smart arse ( unid female)///Vicki s descended from simpletons( American gent)//you haven’t done any cleaning ( unid female)//don’t realise what happened to a member of the angels family//Mrs angel got hurt ( young woman)//these are tapes ///didn’t save Tiggy //police think its Vickis disease//Kassler destroyed Vickis potential ( Kassler niece)//Mo Kassler asked the police to watch relative//turn the heater on( unid female)//Maureen said Bruce advised me//you are a twin ( British gent)//Bruce will get hurt ( Russian gent)// put a child into an airless cylin-der///didn’t wash bra ( British woman)//Simich said Bruce used to be snazzy///unfashionable old slacks ( British woman)//why the police watch ditsy// she is not sane ( Maori female)//loopy makes stains///parent thins Vicki has been sacrificed//she watches a lot of Al Jazeera //dermatology thinks its too late///the police collecting all her buddies//post mad! ( A Thorpe)//destroyers have Vickis papers///Mo Kassler said yippee-GP got rid of her////she is essentially defenceless//why the GP doesn’t want you ( well spoken female)//psychiatrist said she had to be broken //this is MI5 would y ou like to go to the UK?///you will have to go ( British female)/Kassler crashed an ADHB neuro//MI5 cant allow ( British gent)//MI5 destroyed you ( British female)//she does tidy up ( British fe-male)//photo of vicki dressing ( British gent)//the discussion of Dr Audrey Thorpe//Camilla hid secret id ///ooh! Discovered something about Alan//think they are oddballs ( British gent)//police discovered something hidden in hospital ///Mo K said this cat has slashes//police will take you ( Maori female)//Miss Kassler eats nuts in conferences///Its fartso ( Simon Wilson on TV3).////Its Cathy ///you will never know ( young woman)//video of parents in flagrant dilecto//reckon its Italy//psychiatrist has been ringing Dr Zheng (dermatologist)//Vickis is finished ( British female)//Its shower // Mo Kassler thinks she hasn’t been told yet//something horrible hidden in the jew things bathroom ( young woman)//Simich has hidden something terrible in a jar//used to prance around naked ( young Australian? Man)//you will be horrified//Bruce hired a monster American ( female southern US)//police think its snot ( police officer)///Labtests taking payment////Israel crashed the camaro ( Indira TV1)//you have been assassinated ( British gent)//Its Clem Simich ( British gent)//something the Germans did ( British gent)//police reckon its mic ( Hilary TVNZ)//Clem Simich finished all those //you haven’t seen it yet///Mrs Simich says you will go/( British gent)//Mossad discovered fraters pubic ( Russian gent)//something strange about the stuff they are injecting-knocking people off//Bruce said you will need to get out//that is another hard case program ( ref to TVNZ)//Zheng seen meeting Mo Kassler//ADHB said they were some complaints about them//Its sodium chlo-ride///details in an American models case -high crimes and misdemenaours//It’s a codral squamous ! ( British gent)//Bruce said they have photos of Vicki shopping (RNZ)//shock horror case in the Chinese ring//why Adele came//this vicious songstress ( unid male)//discovered a young mother was left for dead//its your residency( poss female police officer)//police not happy with Vickis guff( female police officer?)//the police did once check Vicki diapers ( female interviewed on RNZ)//you might need to wash your hair ( female older woman)//Bruce said it had to be signed//this is the husband of Paris//evening: assorted comments Russian group//disovered the ID of police commissioner//Mary Annes purchases from Century 21 ex bank acct in Dubai//committing comment ex Chinese bus driver bus 941///another complainant is Virginias family//what has been done ( female police officer?)//Mrs Simich said you wont know ( female police officer?)///she changes her sheets once a week ( older woman)//Bruce was married to a relative of the Kennedy family ( presented as a fossil finder) wife found dead in the sand dunes//Vicki was a cleaner ( British wom-an)//something hidden about 4 christmases ago//Its Dunedin -why they got rid of her -J Mulligan RNZ)//Bruce said the last place had cleaners///cut a dogs ears off (young woman)//Vicki must be broken ( Russian female)//something Mossad is spreading around the area///police think its what state did( police officer?)//police watch (female police officer)//have you got the right date ( unid female)//that is the end of the spit ( Russian gent)/why the police commissioner forces ( female police officer)//police don’t like it online ( female police officer)//Simich said there is a lot more evidence ( Maori female)//you have procedures ( Russian female)/discussing this nutter ( tough sounding female)//Mary thinks there is a problem here( female southern US////Mrs Simich says she does know what she is doing ///Russians running the lawyers///Its Mary ( female southern US)//the scars ( unid male)//Its Vickis clothes used to have better pants ( young woman)//I psychiatrist (unid male)// Haumaru said why you are going//Simich meets Maori ring//Haumaru don’t like cancer ( Maori female)//the real Ann Simich is dead//why pressure from Haumaru//police force //why Bruce isn’t staying with his insane sister ( British gent)/you will have to leave Aotearoa ( Maori gent)//why you have got the chop ( unid female)///Its Marxy///Israel think its Nancy//Simich had to get rid of it ( European female //police said there is evidence of dangerous nut in Simichs ( female police officer)//Richard thinks its Vickis happiness //priest has a dastardly?requirement //I did check the disk ( Middle eastern tech )//Vickis toilet is clean ( unid female)//Simich said we will use Vicki to begin with ( Kassler niece)//Brucey said his sister wont get the drive? out ////Russian said t his pilot is no more ///this is Geneva Health (female)//Ann Simich thinks its farty//this cop forces ( British gent)//you might need to make an effort ( unid female//Its died beloved brother ( unid male)//Mrs Simich will destroy you ( older woman aged 70s poss European or Middle east at bus stop Milford?///Vickis finished ( police officer)//wickedness of Ann Simich//Vicki has a lot of sh…t to get rid of ( Italian? Gent)//police wonder why you cant get out ///where did I find a Karcher ( prob ref to Karcher in my storage unit in Whangarei/ extracted 3 small balls from a little girls rectum//she hasn’t done her vacuuming ( young girl)//this minister has had enough ( poss Nanaia Mahuta)//you will have to take those with you///police coming to take stubborn//Social committing ( unid fe-male)/Mrs Clem Simich said you cant stay//this Russian visits Forco-the final point?( Russian gent)//Its clems seizure ( unid male)//Medical disciplinary said would you explain please//Why Mrs Biden has been lying ///Mary sacrificed nutter ( unid female)//Ministers speciality is extreme sadism//found near a tree stump//Bruce met Pearson//Clems wife says she sits there eating biscuits (unid female)//enquiry about ? Ashleigh/Ashley?///police discovered Ashley?////what Bruce did ///that situation could be in trouble//Costa nasty letters ( Kassler niece)//we netted the birds ( Kassler niece)//I didn’t realise there were reports ( British female)//did Simich take that ?//Simich said it has pussy cat photos ( contained in my files )//police think you are a gonner ( female police of-ficer)//Simich contacted young police officers//Its Marys contaminant ( unid female)//why you didn’t have cancer ( British female)//Simich came to end their liesf///she does tidyup ///police say its your excrement ( male police officer)//Mrs Simich did something to take Vicki out of the park ( O ..Kirby TV3)//Kassler car in a garage -painted white -blood on the seat ///New World :female middle east solid build well dressed 50s in New World “waiting for her to leave”/////have to get rid of photos might show happier days ( young woman)//Its Sanaa ( middle eastern female)//broken it ( British gent)/Its Simich sexo ( young girl)//police sacrified an artist ( Russian gent)//Mo Kassler might slaughter catty ( unid female)//why police watch //Israel think its Heath//they made us do it ( unid male)/this business emale police offcer?//the doctor bugged ( male police officer)//wont change channels ( Dr A Thorpe///she was classified as an experimental dumb bunny ( unid fe-male)discovered a middle eastern connection///Mossad uninstalled?( Russian gent)// Melitia ( Jenkins) mother is in real trouble//there has been a terrible punchup with the Simichs//Melitias parent is why she wont stay//police don’t like evidence//an altercation in the Gentles home she tried to sacrifice the kids//Mossad broke in at open with //tech got into serious trouble//what Elizabeth Taylor did (respiratory physician)//police think Mrs Wilson had something hidden in her handbag//Simich thinks this stomach is severely bloated//wont go to HP ( unid female)//you should never live alone ( british gent)//Mrs Simich said it contains a dangerous test ( female police officer)// Pat thought she was a mental defective//Mo Kassler chased after the rubbish///Its your break (Maori female)//priest thinks its bloodlines//An intrusion ( russsian gent)//Mrs Simich getting rid of mind// Simich said Pat Wilson had a mentally impaired kid//Mary sacrificed it beautifully//Mrs Simich wondering if you got your clothes from the dustbin//that is all she has ( young man)//why Simich is destroying ( female police officer?)//there have been shocking consequences ( female police officer?/// why they are doing it ///police were too embarrassed ( female police officer)//something shocking hidden at simichs//an embarrassment in the 60s//she eats her breakfast//you wont leave your clothes on (British gent)//the old Kasslers practiced incest ( unid female)//Ann Simich and young girls//something else in encryption//Simich thinks she lets off (unid female)//Simich said I need those//Africans are quite smart people-Africans smell ( British gent)//Judy Leydons sex ring//Lee Remick possibly in Hilo-poss czar connection//She hasn’t done all her tasks//we have a mic//Details of human parts/she is strangely hysterical ( British gent)//why police sacrificed melanomic ( female police officer?//police….confiscated ( female police officer?)///parent drinks crème de cacao ( British gent)//discovery in the days of president Johnson//Ray Kassler stood down from the air force-poss nazi connections///discovered transcripts in Ann Simichs possession//ditsy in trouble secrets on the net( unid female)//CIA hiding (unid female)//Bruce said the cat would be very distressed ( unid male)//yes they did ( female police officer)// )//British will finish this country //British say its yoghurt ( British gent)//psychiatrist thinks its pets gethsemane//Bruce has been shot in Deal MD//Mo Kassler thinks its another 6 months//Simich said bizzies finished ( young woman)//wooden prints (poss former posssessions of mine)////realised what the Maori ring has been up to //Mrs Simich said it’s the cop/////you have UE ( female police officer?)///remember Pat Smollet//ruthless Mary Wilson did the change ////something in Suffolk’s file -woman mutilated in London ( young woman)///Israel directed to torture///Mo Kassler said she had to be deprived//Bizzies finished (poss female police officer)//found pair dead hanging from a cliff//she mustn’t own ( Kassler niece)//Mo Kassler said she has to be deprived//Vicki will be forced to leave//This is Tamara Suffolk ( the Duchess of Suffolk)//why she wont ( poss female police officer)/Its Jen ( poss Jennifer Anston???)//Its Audrey ( Female chemist Milford-ref to my GP Audrey Thorpe)//Don’t?/Wont? Come back( Audrey Thorpe////discussions of Dr Gentry of North Harbour Medical with LB??///////Vicki is going to be relegated to a slum ( young woman//G Nice is finished ( prob ref to a judge at the ICC)//police think you need to do a blood test//Harassment from Lombards family///Simich has details of 6 months//you need to go to the toilet (unid female)//psychiatrist got rid of Mrs An-gel/////Mossad knocked her off ( British gent) )/Vicki ….assassinated ( elderly Chinese woman wearing a countdown uniform in a Milford chemist)///Audrey ( ref to Dr Audrey Thorp GP) -female chemist asst Milford)////? Dr Sewell meeting Gentry ( principal of North Harbour medical)////Its Sydney people//Mrs Simich said you need to explain yourself//evidence of trickery in Simichs//Kasslers regularly visit Vickis medical practice//you will be taken to the cleaners//you are going to Carrington ( British gent)//Simich keeps blasting//this is Elvis ( male)//Simich commit-ted//Simich had to commit her ( Jack Tame TV1)///she has been committed ( C Luxon of the National Party on TV1)//what did TV find (C Luxon TV1)//police instructed Dr Audrey Thorpe///tenants have Vickis filing system//Mrs Simich contacts Dr Audrey Thorpe//Tanya Parshenko used to go with AW in a secret location///psychiatrist knows its Shields/ Mrs Simich has Vickis citizenship papers////she cant come back-we need her for a sacrifice ( young girl re my cat susy who was attending the vet)// its Mary ( female southern US)//they are a pair of dumsters ( British gent)//Brian said we need to lose a line //reason why a member of this family had to be sacrificed//Karen Sewell ran brain damaging///something hidden in Simichs history//you are being committed ( Maori female)//Ashleigh mixed up dinners //medications //Israel think something in a Vauxhall ( male RNZ)///that will do ( British gent)//priest thinks you are a gonner ( British gent)//you didn’t wash your hair ( British gent)//Susy Murphy handed over intelligence docs to Middle East -marriage breakup///-2nd marriage broke up-3rd marriage to owner ofa fish company-on to Sydney job welcoming passengers and also a madam///Ann Simich said TV3 not retaining Gold program//something has been committed//FBI listening to some old tapes//she really isn’t atrocious//a jacket had a shilling in it///why didn’t Mo Kassler keep her mouth shut//we asset stripped ( British gent)//why you have been destroy ed//this means death//Mossad said Vicki stinks ( American gent)//try and sit up for awhile ( young woman /////Marion Murphy kept ringing the psychiatrist//the police think you were given substances//carcasses on the Kassler farm SPCA arresting//the comments of Bruce Phillips son///Israel shot Christ ( Maori female)//what did the police find in the basement-an old wooden box//why you need a lawyer//your favorite doctor said you had better come in///why you will never get well again//photo of Vicki hurdling in the 1960s-in the British file///who was that ( female southern US)///Bruce said his sister used to eat bubble gum ( British gent)//it spoils the effect ( British gent while I am showering)//Karens genocide ( British gent)//FBI sent Bruces reports to us ( British gent)//59 Devore purchased by Bruce and Mary -left rentals in the hand of Ann Simich//tenant ran a sex ring out of the house-kasslers wrecked the place //why Simich got rid of all that (British gent//Susy will get upset might need to be sedated ( young man)//This is prince Klaus ( Dutch gent)//Israel sacrificed the Hunts//Its Vic (Mo Kassler)//Mo Kassler wears a mask ///police will need all those///why the commissioner is trying to get rid ( female police officer)//info from the Simichs//Israel think its Hart ( prob ref to German container staff member Sydney)//crazy Vicki is going (British gent)/wont save you ( Mo Kassler)//this is the commissioner ( female police officer)//Vicki might need SPCA//Bruce said Vicki should be u sed///ditsys had it ( Mr Chang TVNZ1)//Mrs Simich told to brain damage//Mo K dropped underwear in the lift-asked a young man for sexual favours///something in Dr Liam Wrights ( deceased) file-discussed at the ball///police received photos of porky Vicki Wilson////complaint to Ogg (Australian psychiatrist)//why the psychia-trist is coming//priest said not this time..Mo said this one is Skeeta Davis( prob a CD in my collection)//Mrs Simich has prepared Vickis chamber ( Cath Ryan RNZ)///where did you get that nice sweater from (Maori female)//Ann Simich said she must be detonated//police said these are photos of dead paws//Simich said we begin wth Neve ( female RNZ)////her animal is going to die //police discovered why theft -its embedded( British gent)//Vicki has been transferred ( young woman)//Mrs Simich said where did you get those tops from//she wears baggies…..nice figure ( British fe-male)//priests think this tenancy has tanked //police are escorting journey ( male police officer)//she wont leave NZ //a change in the l ady//this stuff might make you go to the toile t ( British fe-male)//Mrs Simich has started starving///situation because Devonport told lies ///////could you do anything properly//Kassler hiding isotopes//what has been done////we will have to change your brain(unid female)///you lost your chance ( unid female)///why did IA get rid of //Mo Kassler ring bruce//that was unexpected ( Maori female)//Simich has scrapings///the truth did suddenly ap-pear//high Mafia //what has been done in the background//this psychiatrist asked where did you get t hose drugs from( female)//police discovered its Dr A Thorpe//Simich said Vicki goes//what has been found in Noeleen Bridgmans house ( formerly Sr Matthew principal of St Marys College Wgtn//the lies of the relative of Craig Thompson//Mo Kassler running around with the chemist -handed Vickis prescriptions on to Ann Simich//this life is about to be destroyed ( British woman)..this is a humorist ( middle eastern gent)//your were given agent orange////police wonder why you wont leave this place ( male police officer)..////Its Simichs psychiatrist ( male presenter Al Jazeera)//sacrificed an influential psychiatrist ( British gent)//why Al Qaeda got rid of her ///its your pun-ishment//relatives with a local police officer//this relative doesn’t like Vickis prayers//Mrs Simich going to take Susy//this psychiatrist wants to see how she does her taska//Melititas mother has been knocked off// Neve and Jacinda visit Tanya Lankovsky//want to use her for an experiment//Jan Blake Stokes has been consulting a mental hospital//police received salient details about Vic..//this psychiatrist has committal papers//Its displace media//why you didn’t realise//relative said she washes it//evidence of extreme homosexuality in Mossad//Mrs Simich said why you are going//Craig Thompson got into trouble about something in the family file//Dr Thorpe told Maureen Kassler//what was h idden at Thorpes place-photos of 2 dead people///Dacre dropped dead/Mo Kassler said she had to destroy medical consultation///Brad-discovered a missing file why she wasn’t a bright person//A parent brain damaged-Bruce tried to hurt somebody at the school//comments police womens group and a Kassler niece////Kasslers cut off a birds beak//police also discovered all the murders//photos of Milly//you need to clean your teeth ///the latest is Toby ( prob ref to sacrificial dog)///this doctor watches ( male doctor and a Kassler niece at 5 am)////Old light coloured woollen Jacket in J Kasslers wardrobe removed by Susan Kassler -rings in a safe -photos of Pat Wilson seated in a room seemed concerned (poss belongings of Pat and Alan Wilson)/////Simich has details of dead peoplw///she has done her tasks (well spoken female///a murderous death case in Simichs ( young woman)//she does tidy up//this is a girl -lunacy/// hasn’t seen something from 1965///its an achievement ( British gent)///you might need to try the biscuit tin////this is the son of Foss Shanahan -discovered why ///////did you type that//you used to get chilblains///Hart (German) tried to impose ruination///the truth is held by Mossad//police think Vicki has lung can-cer////discovered Vickis records in in Anns place ( young woman)//Kee made a strategic escape ( Asian gent -ref to anatomical lab staff member)///GP sacrificed mental ( Trudi Haumaru communi-ty manager)////vicious Vicki Wilson ( poss female police officer?)///Its Vic (Mo Kassler -evening)//I must have mind ( Ann Simich?)///////police department sacrificed Vicki Wilson (unid male)//Mrs Simich wants your cat //there is another certificate//2 bodies found on a quarry truck//you are being arrested over something in the Simich file( young woman)//relentless harassment from Mary Anne Wilson//Bruce rings doctors//Israel sacrificed an anaesthetist ///she has quite a good figure ( British female)//you h ave been dealt a crushing blow ( young man)//discovered dangerous bauxite //Haumaru need to see what she does ///you need to go w it h men ( young man).//little girl kassler eats excremental sandwich///Carolines husband had a suitcase contained toxic sub-stances /steel band put around the case by FBI////psychiatrist said Vicki has been given maximum dosage//Ann Simich said t here is an order to force Vickis entrapment ( Female RNZ)//she does tidy up //Simich doesn’t like specialists treatment of a head case ( male presenter Al Jazeera)//Israel t hink Vicki has been compromised//nut case ( comment Indian? gent Milford)//Pat knocked Alan off replaced him//you wont be going there//Bulgarian baby down the cliff////don’t like Vicki getting assistance//Kassler said you are not going to get a report//Vicki is leaving something you are not aware of //police think there is evidence of nuclear waste//something in the body after gyno surgery-R Fisher said she mustn’t be told//Simich was told to get on with it//nearly caught Vic ( Mo Kassler)//police told lies about Vicki Wilson//she uses a wettex to clean the floor///serious problem caused by a doctor//why you have been sacrificed//she hasn’t had her antibiotic//this is Mrs Chadwick remember something about coughing//miss kassler is well rounded (British gent)//why you don’t get any better ( young girl)///she isn’t with the royal family ( British gent)//Goldman Saches contacted brother about his sister///this is Hockley//she eats it neatly ( British female)//Haumaru…mental case ( Maori female)//police sacrificed nutty///a death in Apia ( unid female)/Mo Kassler likes visiting nice stuff//we could look after that for you( female British psychiatrist)//Simich doesn’t like ass hole ( Russian gent)//psychiatrist getting rid//Mrs Simich sacrificed a mental case ( Lauren Taylor presenter Al Jazeera)//Simichs complaint going with Jeanette ( Kassler niece)//instigated by mum-to break down family mambers from the linef//Vicki might have to break down ( maori female)//Bruce said they tell me it takes her a long time to get things done //Miss Kassler said Vicki has to be persecuted///realtives say they are hearing funny noises ( male police officer-bathroom)//the Czech police ( Palestinian gent Al Jazeera)//little Vicki was to be used for murderous degradation///she is having her tablets ( Brtish female)//turn it up ( young man re radio)//police think its schizoid ( Cath Ryan RNZ)//did she get her writing pads mixed up ( poss male police officer)//Israelis say its Vickis cancer//police investigating Vickis sexuality//you are in trouble ( unid female)//Israel said she needs to be fingerprinted//photos of young women from the line in Mo kasslers case-some died of unusual ailments////Ann Simich said you are going to Ashburn///Timms ( young man)//old gang made a beeline for somebody living at Simichs//Vics going//and a doctor sacrificed you ( Mo Kassler and gent companion remote viewing- bus to Glenfield)///Clem Simich thinks he had got susys mother over a barrel// Mrs Simich say s Vicki has nice stuff//this is Officer Warnock/Simich gloating -discovered something about Pat///Simich said Vicki wont like it //why she has been assassinated//there is a list in the Embassy//killing young woman from the angels family//police say what they are up to //Simich said bizzie is fin-ished//Mossad contacted police //complaint from Prince Charles also //Ann Simich has a blue painting on the wall //////it’s a bummer Jack Kassler sacrificed you//something in Simichs wont see the light of day//why a New Zealander got away with it//sex parts? ( Russian gent)//Vicki might need to leave quietly (Russian gent)//how did you know that //heard Kassler discussing the way they destroyed Vickis investment////you wont believe what has happened to the old place//Israel displaced mental///Bruce said you will be tied///discovered Riyadh tried to destroy the family//Its Amanda ( unid female)//being kept for slavery ( British gent)//found dead by the car//it’s a secret///police need to see the cat//Mrs Sewell began spreading lies to the medical profession////Bruce said it will cost you//Mrs Dacres hiding out//Mossad think it a silver family//you might need to sit on the toilet( Maori gent)//Bruce deliberately ruined investment////parents experimental ring////media meet the Simichs///you have been committed( unid female)//Alan has caused lies to be told//the reason is wit h Bruce and Mary//Lily Rubin (American fashion house) female middle east//CIA to help ( young man)//these are fried cats ( Kassler girl)//Kassler has been seen meeting ruthless terror ( male presenter RNZ)//serious scandal in Simichs//Bruce said this case goes to Joanna Delahunt ( psychia-trist))//Bruces wife keeps turning up here and lying about Vicki//Ann Simich put on plastic//long history of incontinence (British gent)//Maori thinks a parent has been cemented (British gent)//Mo Kassler plays Agnus Dei ( popular song in 1990s in my collection)//you have unusual perspicacity ( Russian gent)//Hart ( unid male)//Simich started thumping ( British gent)/Its Mary ( female southern US)////psychiatrist sent someone to Te Papapa/ ( Erin weather girl TV1)////Bruce descended from nazi ring///has lovers in Dubai/////the id of Craig Thompsons wife//Miss kassler has been melting down a pet in the oven//psychiatrist said had to destroy Vickis cat ( comment vet at Forest Hill)// you wont see the cat again ( female nurse receptionish Forest Hill)// what the British psychiatrist did visit atrocious lawyer///Bruce thinks you will be horrified//Ann Simich contacted Dr Groen///Mary Anne said they had to get rid of her they stole the money////Bob Thompson (radiology) funded from Middle east /////set up why you will go ( strident sounding female)//why 7 has been knocked off ( unid female)//psychiatrist meets witches ( male presenter Al Jazeera)//comments Russian pair -Miss Kassler uses that too///terrible secret hidden by the family///// discovered details about cancer in Mrs Simichs//vials of her blood in the car//details of a sacrifice in century 21 (Presenter Al Jazeera)//Bruce thought his sister was a bit of a donkey ( Irish gent RNZ)//Ann Simich seen on the patio again( 59 Devore St?)/////Israel think it’s a vial? ( Samantha BBC)/Nurse at Waitemata is a terrorist////where Bruce was buried ( American gent)///certain matters in Simichs file//Hart (Australian gent)//Mrs Simich is going to assassinate you ( British female)//