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Hello Doctor, I am writing in regards to a specific

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Posted on Fri, 8 Feb 2019
Question: Hello Doctor,

I am writing in regards to a specific medical scenario. I am seeking your professional medical opinion on a matter, which I shall set up as a kind of posed scenario, with details as follows...

Patient (which, for all intents and purposes, may or may not be me) has had CT scans of abdomen-pelvis done both *before* and *after* a certain "event," "procedure" or action.

Before sets and after sets of CT scans are provided for reference. All images in both sets have been sized and adjusted from CT scan disc images to be "very near" to same scale, covering same cross-sections, on both sets. Where shown, abdomen is same width in each set, and where length is shown, images show the same corresponding lengths along the same one patient, such that image overlaps may be compared, "flipping one to another and back," for best comparison.

Each set of CT scans, when taken and reviewed by two different radiologists (the second with no knowledge of the first), was marked as showing “no significantly abnormal findings,” with the exception of some constipation and kidneys only slightly out of range of normal size, for the first scan only.

However, the exercise will be as careful observation and to compare/contrast both sets, to remark on differences, and to postulate the relevant possibilities of cause as to account for the difference in what is seen.
…



You can obtain the images that have been uploaded directly to this file storing site, at these links:




(1) https://ufile.io/owpmo

(2) https://ufile.io/pcsbz

(3) https://ufile.io/vzuaw

(4) https://ufile.io/fzemq



and,



(5) https://ufile.io/ojabz

(6) https://ufile.io/1ofhp



…



Please observe the first “before” set, which is the left-hand side.

…



Then, please observe the second “after” set, side-by-side with the respective corresponding images from the first set on the left.

Note the principal outstanding feature is a clearly apparent reduction in abdominal volume. At a superficial glance, this may be single outstanding or notable difference.



Now—for the purposes of this exercise, the nature of the “event” that transpired in-between the “before” and “after” sets will not be explicitly revealed; instead, it will be our exercise to postulate what we do see, and compare it to a hypothesis, establishing both what evidence we have to support the hypothesis, and what evidence we have that might rule it out, if any

.

…



To note: This case is not a typical case. What is being observed in one small aspect of an extremely complex, and medically unprecedented case that covers many different areas and specialties. The details of that will not be examined as of yet, for now, but we will focus only on what is being presented here.

The professional opinion here being sought will be extremely important to establishing and building a certain case, which, as already suggested, is a highly atypical one. I only ask that the radiologist examining this case be open-minded, look very carefully, and take all possibilities that are even remotely plausible as being worthy of high consideration

.

…



Select facts to accept or take as granted, with regards to this case:--

FACTS:


(1) The patient’s weight is anywhere from “a few pounds” to “several pounds” less at the time of the second CT scan, as compared to the weight of the first.

(2) The patient’s blood pressure, normally stable at around 120 - 130, was dropped by 20 - 30 points, to a level of about 100, after the “mystery procedure or action”; this was the blood pressure at or around the time of the second. All other factors are held constant, no change or presence of prescribed meds, no drugs or other circumstances that would alter blood pressure.


To form this as almost a kind of hypothetical test question from a medical school (although this is a very real patient and case, currently unresolved):

“After observing both sets of CT scans and noting the difference between their respective abdominal volumes,

Evaluate the hypothesis that the “mystery procedure” that took place may have been a removal of peritoneal fluid from the patient, either by peritoneal drainage/lavage, or any other means of removal.”



[Note: The two main methods of causing a reduction in a reduction in peritoneal fluid volume, may be via drainage procedure, and also by peritoneal tear.

Generally, for the first, it is generally accepted that procedures such as peritoneal drainage as only undertaken by medical establishments or doctors in cases where ascites is observed, as a means to reduce an observable excess amount of fluid build-up.

For the purposes of this question, the radiologist is asked to ignore this practical reality, instead looking to observe whether such a cause may have been carried out, either legitimately or illegitimately, to produce the effect that we do observe. 

It is also understood that in such a patient, it may not be “all” of the peritoneal fluid removed, but simply enough to restore a proper balance of volume and pressure. Disregard this conventional assumption, too, as being any basis of ruling out or weighing evidence against the likelihood of peritoneal fluid reduction. (Imagine a potential, although completely hypothetical, “basement scenario” where one “self-administers” a peritoneal fluid drain, forcibly removing virtually all peritoneal fluid.)



Furthermore, for the second method described above—peritoneal tear—it is generally accepted that such a tear, although itself usually invisible to a CT scan, would produce trigger manifestations of inflammation and distention within the abdomen that would be picked up.

For this, too, the radiologist is here asked to ignore this presumption: instead, the radiologist is asked to take for granted and accepted that the patient here in question has chronically high levels of a combination of drugs (not limited to vasoconstrictors (a kind of which is known to cause intestinal ischemias……(big hint)), and gabapentinoids and/or voltage-gated calcium channel blockers—though not gabapentin) that prevent any significant manifestation of inflammation whatsoever in the patient that would otherwise be evident in someone from a normal population—and also understand that other doctors, in other areas of specialty, have made the observation that inflammation was lacking, producing a “false negative” on other types of X-ray imaging, where other tests and observations showed there to be very serious presence of infection and potential damage; the lack of expected inflammation was noted as both being “real” and also “highly unusual.”



While peritoneal tears may normally present obvious inflammation, assume this patient is rendered incapable of producing inflammation that would otherwise be picked up on a CT scan.]



Furthermore:



“(1) Estimate the amount of both volume as well as weight that can be visually estimated, that is apparently lost in the patient between the “before” scan and the “after” scan.



(2) Estimate either the amount or proportion of peritoneal fluid present in the patient in the “before” set.



(3) Estimate the amount of proportion of peritoneal fluid present within the patient in the “after” set.



(4) How do the two volumes compare? What estimation is given as to the quantity of reduction, if any?



(5) With the understanding that the peritoneal chamber(s) are a “sealed volume” within the male mammal, does a finding of there having been “any significant reduction” of peritoneal volume or fluid that is apparent imply that peritoneal fluid may have been mechanically or physically removed, either by intention, or by any other potential or inadvertent means of escape? Consider all facts given above.



(6) What other factors can account for any abdominal volume change? List: change in
 (a) intestinal volume (gas, matter, constipation, etc);
 (b) significant change or decrease in fat distribution, as reflected by proportional distributions of subcutaneous and visceral* fat volumes
 (c) changes in lung air volume

Furthermore, add any other factors that may be left out.



(7) Evaluate the potentiality of each of those factors, with each of them either admitting them as likely or ruling them out as unlikely.



(8) Establish an estimated probability chart, where out of a total of 100% of the “pie” among all of them, each of the few or several possible contributing factors are given a percentage rating as to how much to the total volume change they may be contributing.



(9) What is the leading suspected cause or assessment? 

 (a) If it is “apparent reduction of peritoneal volume by some unknown or unreported event,” please render the final opinion that “The most probable explanation and cause for the observed change in abdominal volume, along with other facts and symptoms reported alongside, is a reduction in peritoneal volume.”

 (b) If it is any cause other than peritoneal volume, then would there be enough evidence against the “peritoneal hypothesis” to rule it out completely? Can the opinion of “No peritoneal volume change” be supported by any observation that the before and after sets both contain the same exact amount of peritoneal fluid volume, if they do?”



(10) If peritoneal fluid volume reduction is ruled out, what does account for the totality of the volume reduction observed?



…



Before answering the above questions, please note the additional facts:
--

FACTS, CONTINUED FROM EARLIER:


(3) Patient reports living in a very cold climate. He also reports that, due to being acclimated to the cold, he extremely rarely, if ever, feels any cold in sub-freezing temperatures ranging from 20 - 30 degrees fahrenheit, while wearing a thin coat. This is regardless of any change in any relevant factor, such as fat stores, intestinal content, etc. The patient also reports that, immediately after the “event” that happened, all of a sudden, anytime temperatures dropped from room temperature (72 - 77 degrees) to a range within 40 - 60 degrees, the patients has found tremendous XXXXXXX at both experience tremendous cold, involuntary and violent shivers, as well as limbs that are drastically colder than the limbs of others around him when touching his hands. At 40 degrees, even while wearing double-or-triple coats, he is still violently shivering cold, with limbs drastically colder than anyone else standing around him with only a shirt or sweater on; this may suggest lowering of core body temperature, which has never been reported as a phenomenon until immediately after the “mystery event.”


(4) Patient notes not only himself notes and observes the reduction of volume, but also notes a drastic reduction in outward pressure from his abdomen. In his own words:

“All my life I had at least a slight pot belly, no matter how much weight I lost. There was never any kind of dip below the ribs—but more importantly, whenever I’d press against my loosened belly, there’d always be resistance, presumably by the sheer volume and weight of the internal abdominal matter. Imagine a bread bag—imagine filling up the plastic bread bag up all the way with water and tying it, and then holding it in one hand, while you poke with a finger at the bottom of any one of the sides. The sheer pressure of the volume would resist your finger, you wouldn't be able to press in far at all.

Now, since [the mystery event], it’s not just that my abdomen has lost 40% of its height when I lie down (verifiable on CT images), but when I’m standing…now when I press against the lower belly into my gut, there’s virtually no pressure, no resistance. It is such a strange feeling. I can press in, and it goes almost all the way to the inside edge of my spine—no exaggeration. It is like pressing into a loosely hanging curtain with no resistance. Imagine pouring 90 percent of the water out of that water bag and tying it back up again. It’s flimsy, you can press in with a finger and there’s no pressure anymore, you can push all the way in till you press the inside edge of the other side of the plastic bag. There’s no more resistance. That’s what my abdomen feels like now.”




One student, who is not a licensed doctor nor had had any kind of radiological nor gastrointestinal training, offers this in support:



“The images I see show a clear reduction in abdominal volume, ranging from 10 - 40 percent of torso height. What concerns me the most is the relative uniformity of the decrease in torso thickness. The peritoneal volume technically extends from the pelvic floor, all the way up to the top, real up to about the level of person’s throat. If there were a sudden change of intestinal volume by gas or removal of long-term constipation, we would expect some lower-belly thinness. But the thickness of the upper chest compartment is more than 10 percent thinner—closer to 20 percent(!!!). Only peritoneal volume extends to the area around the lungs. If the lungs are held the same (full of air to the XXXXXXX as per instruction which patient reports to have followed), there should be no change. if the instruction are blatantly disregarded, I can still observe by measuring my own torso thickness and the patient’s as well, that breathing in and out does not cause the chest to rise and fall in that large of a proportion relative to the torso’s thickness.

Furthermore, it seems intuitive that the drastic, sudden increase in cold comes as a result of a decrease in mammalian insulation. Normally, we think of fat as the primary insulator against the cold. However, the organs are surrounded by peritoneal fluid primarily, which also contributes a very large proportion of thermal insulation; if a sudden change occurs that causes a reduction in peritoneal volume, the sensors around the internal organs would sense that they are FREEZING COLD. Ice cold hands show that the body is trying to re-route blood to the internal organs to deliver heat to those critical organs, because or some radical change it seems to be perceiving.

Additionally, a drastic lowering in blood/“body” pressure is revealing. A smaller abdomen with unchanged pressure is one thing. But a smaller abdomen with drastically reduced local pressure too, as well as systemic pressure, is a big sign that some mass or volume, as crazy as it would normally sound, may have been removed.”



...

Others, playing the role of devil’s advocate, note the following objections:



- “According to some sources online, there are only 5 - 20 mL of peritoneal In the cavity of a healthy male. More than this cannot have been removed; therefore, I have no reason to believe that the patient is not in perfectly good health.”



- “Infiltration or tearing of the peritoneum, which is called peritonitis, is extremely rare and also presents inflammation, pain, and many other symptoms and complication that would be normally outwardly visible. Because these other signs do not appear, I have no reason to believe that there has been any such change.”



...

However, to refute these claims:



(1) Despite “normal” subjects showing very little peritoneal fluid, in many cases, it is somewhat common to find multiple liters of peritoneal fluid being extracted from patients in hospital settings that suffer from different degrees of “ascites.” It cannot be ruled out that there are subsets of the population that carry on with personal norms of fluid that is “chronic, low-grade” levels of increase, approaching (but not fully reaching) the few liters of volume we normally associate with ascites.

Furthermore, some information seems to suggest that there are multiple sub-pockets or sub-chambers/sub-volumes that comprise the totality of the inter-organ abdominal space. Intuitively, it seems a strange conclusion to find from a study showing an ability to only draw out 10 mL of fluid from a small set of patients, when one can routinely see many liters drawn out of patients in hospitals. This leads me to believe that the methodology of the study was flawed, and that perhaps they were only accessing one small sub-compartment from which to draw.



(2) Rarity does not rule out an issue—only circumstances and facts do. The one rendering the opinion on the lack of other symptoms was not given the information that the patient has demonstrated, as a result of chemical action, a long-term inability to manifest inflammation or swelling, as a result of certain circumstances that will not be explored here at this time

.

…



After considering all facts carefully and analyzing CT images, please complete the items above and render the final opinion, preferably in the following form:



“I find it to be approximately ____________ % likely or sure, that the reduction in abdominal volume observed, along with the sum total of all other facts and symptoms reported, are all explained by the one sole factor of reduction in peritoneal volume, by whatever miscellaneous action to have caused the reduction—



--with the remaining __________ % being my belief that both the reduction of abdominal volume reduction and the entire set of symptoms are completely unrelated to any change in peritoneal volume, with all symptoms being explained by the following explanations with necessarily exclude peritoneal volume reduction: (list all causes and explanations to account for the totality of what is observed, if the percentage given to here is anything other than ‘-0- percent’).”



…



A technically-satisfying answer may merit a debrief with further information, as well as an opportunity to work on further details and make further opinions on additional information that may be made available on this case.



Thank you for your time and consideration.
default
Follow up: Dr. Vivek Chail (0 minute later)
Hello Doctor,

I am writing in regards to a specific medical scenario. I am seeking your professional medical opinion on a matter, which I shall set up as a kind of posed scenario, with details as follows...

Patient (which, for all intents and purposes, may or may not be me) has had CT scans of abdomen-pelvis done both *before* and *after* a certain "event," "procedure" or action.

Before sets and after sets of CT scans are provided for reference. All images in both sets have been sized and adjusted from CT scan disc images to be "very near" to same scale, covering same cross-sections, on both sets. Where shown, abdomen is same width in each set, and where length is shown, images show the same corresponding lengths along the same one patient, such that image overlaps may be compared, "flipping one to another and back," for best comparison.

Each set of CT scans, when taken and reviewed by two different radiologists (the second with no knowledge of the first), was marked as showing “no significantly abnormal findings,” with the exception of some constipation and kidneys only slightly out of range of normal size, for the first scan only.

However, the exercise will be as careful observation and to compare/contrast both sets, to remark on differences, and to postulate the relevant possibilities of cause as to account for the difference in what is seen.
…



You can obtain the images that have been uploaded directly to this file storing site, at these links:




(1) https://ufile.io/owpmo

(2) https://ufile.io/pcsbz

(3) https://ufile.io/vzuaw

(4) https://ufile.io/fzemq



and,



(5) https://ufile.io/ojabz

(6) https://ufile.io/1ofhp



…



Please observe the first “before” set, which is the left-hand side.

…



Then, please observe the second “after” set, side-by-side with the respective corresponding images from the first set on the left.

Note the principal outstanding feature is a clearly apparent reduction in abdominal volume. At a superficial glance, this may be single outstanding or notable difference.



Now—for the purposes of this exercise, the nature of the “event” that transpired in-between the “before” and “after” sets will not be explicitly revealed; instead, it will be our exercise to postulate what we do see, and compare it to a hypothesis, establishing both what evidence we have to support the hypothesis, and what evidence we have that might rule it out, if any

.

…



To note: This case is not a typical case. What is being observed in one small aspect of an extremely complex, and medically unprecedented case that covers many different areas and specialties. The details of that will not be examined as of yet, for now, but we will focus only on what is being presented here.

The professional opinion here being sought will be extremely important to establishing and building a certain case, which, as already suggested, is a highly atypical one. I only ask that the radiologist examining this case be open-minded, look very carefully, and take all possibilities that are even remotely plausible as being worthy of high consideration

.

…



Select facts to accept or take as granted, with regards to this case:--

FACTS:


(1) The patient’s weight is anywhere from “a few pounds” to “several pounds” less at the time of the second CT scan, as compared to the weight of the first.

(2) The patient’s blood pressure, normally stable at around 120 - 130, was dropped by 20 - 30 points, to a level of about 100, after the “mystery procedure or action”; this was the blood pressure at or around the time of the second. All other factors are held constant, no change or presence of prescribed meds, no drugs or other circumstances that would alter blood pressure.


To form this as almost a kind of hypothetical test question from a medical school (although this is a very real patient and case, currently unresolved):

“After observing both sets of CT scans and noting the difference between their respective abdominal volumes,

Evaluate the hypothesis that the “mystery procedure” that took place may have been a removal of peritoneal fluid from the patient, either by peritoneal drainage/lavage, or any other means of removal.”



[Note: The two main methods of causing a reduction in a reduction in peritoneal fluid volume, may be via drainage procedure, and also by peritoneal tear.

Generally, for the first, it is generally accepted that procedures such as peritoneal drainage as only undertaken by medical establishments or doctors in cases where ascites is observed, as a means to reduce an observable excess amount of fluid build-up.

For the purposes of this question, the radiologist is asked to ignore this practical reality, instead looking to observe whether such a cause may have been carried out, either legitimately or illegitimately, to produce the effect that we do observe. 

It is also understood that in such a patient, it may not be “all” of the peritoneal fluid removed, but simply enough to restore a proper balance of volume and pressure. Disregard this conventional assumption, too, as being any basis of ruling out or weighing evidence against the likelihood of peritoneal fluid reduction. (Imagine a potential, although completely hypothetical, “basement scenario” where one “self-administers” a peritoneal fluid drain, forcibly removing virtually all peritoneal fluid.)



Furthermore, for the second method described above—peritoneal tear—it is generally accepted that such a tear, although itself usually invisible to a CT scan, would produce trigger manifestations of inflammation and distention within the abdomen that would be picked up.

For this, too, the radiologist is here asked to ignore this presumption: instead, the radiologist is asked to take for granted and accepted that the patient here in question has chronically high levels of a combination of drugs (not limited to vasoconstrictors (a kind of which is known to cause intestinal ischemias……(big hint)), and gabapentinoids and/or voltage-gated calcium channel blockers—though not gabapentin) that prevent any significant manifestation of inflammation whatsoever in the patient that would otherwise be evident in someone from a normal population—and also understand that other doctors, in other areas of specialty, have made the observation that inflammation was lacking, producing a “false negative” on other types of X-ray imaging, where other tests and observations showed there to be very serious presence of infection and potential damage; the lack of expected inflammation was noted as both being “real” and also “highly unusual.”



While peritoneal tears may normally present obvious inflammation, assume this patient is rendered incapable of producing inflammation that would otherwise be picked up on a CT scan.]



Furthermore:



“(1) Estimate the amount of both volume as well as weight that can be visually estimated, that is apparently lost in the patient between the “before” scan and the “after” scan.



(2) Estimate either the amount or proportion of peritoneal fluid present in the patient in the “before” set.



(3) Estimate the amount of proportion of peritoneal fluid present within the patient in the “after” set.



(4) How do the two volumes compare? What estimation is given as to the quantity of reduction, if any?



(5) With the understanding that the peritoneal chamber(s) are a “sealed volume” within the male mammal, does a finding of there having been “any significant reduction” of peritoneal volume or fluid that is apparent imply that peritoneal fluid may have been mechanically or physically removed, either by intention, or by any other potential or inadvertent means of escape? Consider all facts given above.



(6) What other factors can account for any abdominal volume change? List: change in
 (a) intestinal volume (gas, matter, constipation, etc);
 (b) significant change or decrease in fat distribution, as reflected by proportional distributions of subcutaneous and visceral* fat volumes
 (c) changes in lung air volume

Furthermore, add any other factors that may be left out.



(7) Evaluate the potentiality of each of those factors, with each of them either admitting them as likely or ruling them out as unlikely.



(8) Establish an estimated probability chart, where out of a total of 100% of the “pie” among all of them, each of the few or several possible contributing factors are given a percentage rating as to how much to the total volume change they may be contributing.



(9) What is the leading suspected cause or assessment? 

 (a) If it is “apparent reduction of peritoneal volume by some unknown or unreported event,” please render the final opinion that “The most probable explanation and cause for the observed change in abdominal volume, along with other facts and symptoms reported alongside, is a reduction in peritoneal volume.”

 (b) If it is any cause other than peritoneal volume, then would there be enough evidence against the “peritoneal hypothesis” to rule it out completely? Can the opinion of “No peritoneal volume change” be supported by any observation that the before and after sets both contain the same exact amount of peritoneal fluid volume, if they do?”



(10) If peritoneal fluid volume reduction is ruled out, what does account for the totality of the volume reduction observed?



…



Before answering the above questions, please note the additional facts:
--

FACTS, CONTINUED FROM EARLIER:


(3) Patient reports living in a very cold climate. He also reports that, due to being acclimated to the cold, he extremely rarely, if ever, feels any cold in sub-freezing temperatures ranging from 20 - 30 degrees fahrenheit, while wearing a thin coat. This is regardless of any change in any relevant factor, such as fat stores, intestinal content, etc. The patient also reports that, immediately after the “event” that happened, all of a sudden, anytime temperatures dropped from room temperature (72 - 77 degrees) to a range within 40 - 60 degrees, the patients has found tremendous XXXXXXX at both experience tremendous cold, involuntary and violent shivers, as well as limbs that are drastically colder than the limbs of others around him when touching his hands. At 40 degrees, even while wearing double-or-triple coats, he is still violently shivering cold, with limbs drastically colder than anyone else standing around him with only a shirt or sweater on; this may suggest lowering of core body temperature, which has never been reported as a phenomenon until immediately after the “mystery event.”


(4) Patient notes not only himself notes and observes the reduction of volume, but also notes a drastic reduction in outward pressure from his abdomen. In his own words:

“All my life I had at least a slight pot belly, no matter how much weight I lost. There was never any kind of dip below the ribs—but more importantly, whenever I’d press against my loosened belly, there’d always be resistance, presumably by the sheer volume and weight of the internal abdominal matter. Imagine a bread bag—imagine filling up the plastic bread bag up all the way with water and tying it, and then holding it in one hand, while you poke with a finger at the bottom of any one of the sides. The sheer pressure of the volume would resist your finger, you wouldn't be able to press in far at all.

Now, since [the mystery event], it’s not just that my abdomen has lost 40% of its height when I lie down (verifiable on CT images), but when I’m standing…now when I press against the lower belly into my gut, there’s virtually no pressure, no resistance. It is such a strange feeling. I can press in, and it goes almost all the way to the inside edge of my spine—no exaggeration. It is like pressing into a loosely hanging curtain with no resistance. Imagine pouring 90 percent of the water out of that water bag and tying it back up again. It’s flimsy, you can press in with a finger and there’s no pressure anymore, you can push all the way in till you press the inside edge of the other side of the plastic bag. There’s no more resistance. That’s what my abdomen feels like now.”




One student, who is not a licensed doctor nor had had any kind of radiological nor gastrointestinal training, offers this in support:



“The images I see show a clear reduction in abdominal volume, ranging from 10 - 40 percent of torso height. What concerns me the most is the relative uniformity of the decrease in torso thickness. The peritoneal volume technically extends from the pelvic floor, all the way up to the top, real up to about the level of person’s throat. If there were a sudden change of intestinal volume by gas or removal of long-term constipation, we would expect some lower-belly thinness. But the thickness of the upper chest compartment is more than 10 percent thinner—closer to 20 percent(!!!). Only peritoneal volume extends to the area around the lungs. If the lungs are held the same (full of air to the XXXXXXX as per instruction which patient reports to have followed), there should be no change. if the instruction are blatantly disregarded, I can still observe by measuring my own torso thickness and the patient’s as well, that breathing in and out does not cause the chest to rise and fall in that large of a proportion relative to the torso’s thickness.

Furthermore, it seems intuitive that the drastic, sudden increase in cold comes as a result of a decrease in mammalian insulation. Normally, we think of fat as the primary insulator against the cold. However, the organs are surrounded by peritoneal fluid primarily, which also contributes a very large proportion of thermal insulation; if a sudden change occurs that causes a reduction in peritoneal volume, the sensors around the internal organs would sense that they are FREEZING COLD. Ice cold hands show that the body is trying to re-route blood to the internal organs to deliver heat to those critical organs, because or some radical change it seems to be perceiving.

Additionally, a drastic lowering in blood/“body” pressure is revealing. A smaller abdomen with unchanged pressure is one thing. But a smaller abdomen with drastically reduced local pressure too, as well as systemic pressure, is a big sign that some mass or volume, as crazy as it would normally sound, may have been removed.”



...

Others, playing the role of devil’s advocate, note the following objections:



- “According to some sources online, there are only 5 - 20 mL of peritoneal In the cavity of a healthy male. More than this cannot have been removed; therefore, I have no reason to believe that the patient is not in perfectly good health.”



- “Infiltration or tearing of the peritoneum, which is called peritonitis, is extremely rare and also presents inflammation, pain, and many other symptoms and complication that would be normally outwardly visible. Because these other signs do not appear, I have no reason to believe that there has been any such change.”



...

However, to refute these claims:



(1) Despite “normal” subjects showing very little peritoneal fluid, in many cases, it is somewhat common to find multiple liters of peritoneal fluid being extracted from patients in hospital settings that suffer from different degrees of “ascites.” It cannot be ruled out that there are subsets of the population that carry on with personal norms of fluid that is “chronic, low-grade” levels of increase, approaching (but not fully reaching) the few liters of volume we normally associate with ascites.

Furthermore, some information seems to suggest that there are multiple sub-pockets or sub-chambers/sub-volumes that comprise the totality of the inter-organ abdominal space. Intuitively, it seems a strange conclusion to find from a study showing an ability to only draw out 10 mL of fluid from a small set of patients, when one can routinely see many liters drawn out of patients in hospitals. This leads me to believe that the methodology of the study was flawed, and that perhaps they were only accessing one small sub-compartment from which to draw.



(2) Rarity does not rule out an issue—only circumstances and facts do. The one rendering the opinion on the lack of other symptoms was not given the information that the patient has demonstrated, as a result of chemical action, a long-term inability to manifest inflammation or swelling, as a result of certain circumstances that will not be explored here at this time

.

…



After considering all facts carefully and analyzing CT images, please complete the items above and render the final opinion, preferably in the following form:



“I find it to be approximately ____________ % likely or sure, that the reduction in abdominal volume observed, along with the sum total of all other facts and symptoms reported, are all explained by the one sole factor of reduction in peritoneal volume, by whatever miscellaneous action to have caused the reduction—



--with the remaining __________ % being my belief that both the reduction of abdominal volume reduction and the entire set of symptoms are completely unrelated to any change in peritoneal volume, with all symptoms being explained by the following explanations with necessarily exclude peritoneal volume reduction: (list all causes and explanations to account for the totality of what is observed, if the percentage given to here is anything other than ‘-0- percent’).”



…



A technically-satisfying answer may merit a debrief with further information, as well as an opportunity to work on further details and make further opinions on additional information that may be made available on this case.



Thank you for your time and consideration.
doctor
Answered by Dr. Vivek Chail (2 days later)
Brief Answer:
There is a continuous movement of fluids between systems in humans

Detailed Answer:
Hi,
Thanks for writing in to us.

I have read your query in detail.

The following links are not working/ not allowing me to download the images so it is requested that you may use an alternative file sharing facility. You can send the images at YYYY@YYYY and address it to my name: Dr Vivek Chail

I have had a look at the 3 screen shots which are uploaded to your query.

Peritoneal fluid volume in a person is a dynamic variable. The fluid content in various compartments is balanced by our system to maintain homeostasis. Unless there is an obvious excessive volume of peritoneal fluid as in ascites or any pathological condition, it is really difficult and nearly impossible to measure the volume.

The volume of circulating peritoneal fluid will change with the exchange of fluids, nutrients and gases in the peritoneum, in the blood and in the lungs. The balance is maintained by a multifactorial set of events in the body.

It is not easy as a radiologist to give a "pie chart" illustration of the contribution of the above processes as they work in coalition and are not mutually independent.

Other than peritoneal fluid, there are many other body fluids including the digestive juices, bile, blood, pleural fluid, cerebrospinal fluid and other intra cellular and extra cellular fluids. There are demarcated areas where certain fluids are collection however there is continuous movement of molecules causing a state of dynamic fluid movement across various systems.

Please do write back with your doubts.
Regards,
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
doctor
Answered by Dr. Vivek Chail (0 minute later)
Brief Answer:
There is a continuous movement of fluids between systems in humans

Detailed Answer:
Hi,
Thanks for writing in to us.

I have read your query in detail.

The following links are not working/ not allowing me to download the images so it is requested that you may use an alternative file sharing facility. You can send the images at YYYY@YYYY and address it to my name: Dr Vivek Chail

I have had a look at the 3 screen shots which are uploaded to your query.

Peritoneal fluid volume in a person is a dynamic variable. The fluid content in various compartments is balanced by our system to maintain homeostasis. Unless there is an obvious excessive volume of peritoneal fluid as in ascites or any pathological condition, it is really difficult and nearly impossible to measure the volume.

The volume of circulating peritoneal fluid will change with the exchange of fluids, nutrients and gases in the peritoneum, in the blood and in the lungs. The balance is maintained by a multifactorial set of events in the body.

It is not easy as a radiologist to give a "pie chart" illustration of the contribution of the above processes as they work in coalition and are not mutually independent.

Other than peritoneal fluid, there are many other body fluids including the digestive juices, bile, blood, pleural fluid, cerebrospinal fluid and other intra cellular and extra cellular fluids. There are demarcated areas where certain fluids are collection however there is continuous movement of molecules causing a state of dynamic fluid movement across various systems.

Please do write back with your doubts.
Regards,
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
default
Follow up: Dr. Vivek Chail (2 days later)
Thank you for your well-thought out reply.

It is a proper answer, that discusses the reality of the uncertainty of peritoneal volumes, as well as their dynamic changes.

While I will continue to ask other Radiologists for their opinions, I find your answer and thought process interesting--I would like to share more details with you, which may potentially change your mind about the nature of the circumstances.

I thank you for the time and energy you've invested, and I thank you as well in advance for your continued interest in my very concerning case.

First of all: Yes--these scans are of my own abdomen.

The reason I framed the question the way I did, is because I wanted to see if the reality of the truth of the scenario can be uncovered from just the comparison of the CT scans alone, without having to stand on additional facts or information related to the circumstances.

However, it seems to me that, in the absence of clarity from a objective radiological diagnostic, I will go in deeper to explain the back story of what has been happening.

Please note: the whole backstory is very long, in short, a kind of chemical/drug poisoning that took place a couple years ago, has radically changed my life, and also produced a downstream cascade of effects and complications, which most recently, have included severe...what we will call "abdominal" issues, though I am extremely certain on my own self-assessment of exactly what is going on. I will cover the most pertinent information at this step--and as our discussion unfolds, I will cover more information, working backwards or "reverse engineering" the scenario, step-by-step, until we arrive at a bird's eye view of the entire problem. The goal will be to build and illustrate a case in which there is enough supporting and circumstantial evidence that it becomes virtually presumptive, with little room for serious or reasonable doubts.

Regarding the fluid dynamism and volume change of the peritoneum: we can accept it to be true that the body is constantly shifting its internal fluid volumes and pressures, in order to always strive towards homeostasis. Our first task, philosophically or investigational at least, is to assess what the normal range of fluctuation would be in a person who does not undergo any radical procedure, accident, or sudden change in medication or health. Imagine a statistical normal distribution curve, where the expected value is the average volume of the peritoneal space--and abdominal volume--of a given man. There is also some standard deviations, within minute to minute, day to day--and with that, over the long term, we have an expectation of what range this person's abdominal volume may change.

The first question, is to evaluate whether the shift from "before" volume to "after" volume is within the normal 2 - 3 standard deviations of the average peritoneal flow for this given person--or for any person, if this person is typical. If the patient himself, who knows his own peritoneal and abdominal size best, would say that "every now and then, though the natural fluctuations of my internal fluids, my peritoneum and abdomen can become this deflated," then it is within the natural course of fluctuations, and radiologists may expect to see such drastic changes within peritoneal volume.

But if it is not...

...If, for example, the patient says, "it was always within this range, and now after the catalyzing event, my peritoneal volume instantly and suddenly became at a level that may easily be....15 or 20 standard deviations below normal....

Then we must assume that some event that is not within the normal flow of homeostasis has transpired; that something clinically significant is afoot.

(1) Any thoughts on this? Also, upon closer inspection, does the volume of change seem within the normal expected range (two or three standard deviations of normal shift), or not?

(2) Are there any medical sources that state how much, or by what percentage, peritoneal fluids may naturally decrease without outside action? We know that fluids may increase via processes related to the onset of ascites--but how often to they decrease, completely on their own?

...

I will resume where I left off with the story:

The mystery event that catalyzed the sudden, drastic change....was an enema.

Allow me to set-up the relevant details.

Firstly, it should be understood, or at least assumed and taken for granted as part of this exercise, that the following factors are at play:

First, I have remained poisoned with a set of drugs/chemicals that, for all intents and purposes, inhibit nociception (pain response & perception, as well as psychological response to pain), reflexes (via lowering of the CNS activity), inflammation capacity, and also very critically, due to CNS suppression, the drug-metabolizing microsomes of the liver has virtually ceased completely in their activity (hence the long term poisoning).

Second, one of the drugs that had more recently been added to the mixture, has been cocaine: cocaine, as a vasoconstrictor, acts very harshly on intestinal tissue when it is there; as a result of remaining within the tissue matrix, unmetabolized cocaine is known medically to produce cases around the world of intestinal ischemias (look up more on this to verify); these ischemias are caused by a kind of "brittle" action, where the cocaine causes the tissues to become not only hard, but extremely rigid and inflexible, like turning a fresh new rubber band into an old one. Intestinal tissue must undergo the highest degree and proportionality of manual stretch within the body, relative to any other tissue; this is why in cases of cocaine use, intestinal ischemias are the first kind that doctors discover.

And, to further point out, take it for granted that this cocaine was present within the body--not just in blood, but mostly in fatty lipid tissue (cell membranes etc), as cocaine has 50x more soluble preference for lipids & fats than for water-based compartments.

...

One day, I decided to do a coffee enema. I had done a few of them before, but this time, I decided I was going to be "extra aggressive" with them. I decided to increase the temperature of the water, and also decided to conduct some new, forceful type of abdominal contractions to pump the water though. In selecting the temperature of the water I decided to use a trick that mothers are known to use, by testing the temperature of the water on the backs of their hands to keep it just below the point that it would sting or burn, in order to keep it within a safe level of warmth. I boiled a pot of coffee, and then eventually did this test; however, what I failed to realize consciously, was that my pain receptors--as a result of both GABA-ergic drug poisoning, as well as strong cocaine presence--were not responsive. I felt the pleasant warmth of the water, which in hindsight, had to have been about 140 - 150 degrees or more.


My insides and colon were virtually empty from a fast I had been doing. I had also just completed an enema with only warm water, to flush out any waste material before hand (of which there was virtually none.) No gas or any other additional features.

I took this coffee, placed it in an enema bucket hung above, and poured it in; pain receptors having been almost completely inactivated for months at this point, I felt no discomfort whatsoever. Additionally, I began pumping extremely vigorously, with my diaphragm muscles, the water throughout my colon--basically initiating a highly dangerous phenomenon known in the engineering as "water hammer"--when the pressure of traveling water within a tube system compounds and builds EXPONENTIALLY at the end site of absorbtive impact, where large damage can often occur in piping systems of any kind due to the changing velocity of water as it is pumped within a system.

They say hindsight is 20/20. However, at that moment, I was determined to rinse my bowels with hot coffee water, all the way until a certain point, that I felt one of the most reverberating sensations of my life, which I both felt inside and heard outside, as a drastic--

--"POP!!!"

...I stop. I slowly get up. I empty out all the waste water--however, what seemed very strange were TWO distinct things that I remember very well: firstly, the volume of liquid coming out seemed to be higher in quantity than the amount I had placed in.

And, secondly, I recall very clearly, smelling the waste water...

--It had an EXTREMELY unique smell, unlike anything I have ever smelled before. The best way I could describe this smell, intuitively, even before I reasoned what this fluid most likely had to be (which took a few hours), would be like the smell of "organ fluid..."

The closest things I have ever smelled to that odor, were the odors that I have smelled whenever my family would buy liver or kidneys to cook and eat, which has happened only a few times in my life--it was a kind of "organ" smell, which does not resemble in any way the smell of intestinal matter nor any smell or taste associated with bile.

Distinct, too, was the *feel* and texture of the liquid. I have done enemas and coffee enemas with water before. I have passed waste many times in my life, each time using toilet paper to separate my fingers from the waste as I wipe, while essentially feeling and taking for granted the texture of the matter.

But this fluid? When I wiped with toilet paper... It felt like no feeling I've ever felt around my anus. It felt like GREASE. It was extremely slick reminding one almost of lubricant gels. Several separate toilet paper wipes were required to de-slick that oily texture off of my anus after releasing that fluid, which felt like a million miles away from anything I've ever felt.

--But different too, as well, was the COLOR of the fluid... For when I finally got up and examined the toilet bowl, not only was the "organ-fluid"-like odor coming up, but the COLOR was different too. It wasn't the color of the yellowish coffee (light roast special for coffee enemas) that I usually see. It wasn't the color of waste matter, of which there was none. it wasn't the color of bile, either, the orange-yellowish color of which I've grown accustomed to seeing very regularly after my liver issues started in 2016, since the poisoning.

It was an extremely distinct hue of color that I've never seen before, that stood out remarkably. It was almost a kind of yellowish-GREEN. Very specific, hard to describe, but knowing it was distinctly and extremely different from anything ever observed.

This, plus the smell, plus the feel, all while knowing this happened after a large POPPING BURST cause by unnaturally high pressure of extremely high-temperature water in my colon, drove me to the conclusion that something may have been pulled from the abdomen that wasn't supposed to be removed.

But what could it have been?

I stood up, went out into the hallway, where my mother was. I was shirtless; she looked at me, stunned, and said "What happened to your belly?"

I stood in profile, and looked at myself in the mirror.

About several pounds worth of volume were gone--to the point of looking unnatural. At my lowest weight in my life many years ago, I never had my abdomen dip below/behind my ribs so as to have them stick out--and yet, here they were. Additionally, not only was the thickness of my abdomen drastically reduced--but my rib cage, too, was NOTICEABLY THINNER. My rib cage--which, in all my adult life, has never suddenly changed in thickness. That would be impossible.

It looked like someone took a large piece of mass out of my belly--as if someone did instantaneous surgery and removed tremendous amounts of three-dimensional volume from my entire torso.

I stepped on a scale. Surely enough, I weighed SEVERAL pounds less than I did the prior evening. Blood pressure was at 100, which is 30 points below my consistent level.

There was one other stand-out feature, too. I am a personal trainer, and know my body very well--my balance when moving and walking, and things of that nature. I know and feel it very well, and very accurately. However, upon standing up and walking after the enema pop, my own CENTER OF GRAVITY shifted--both DOWN, and towards the rear.

Only a removal of volume from the front part of the upper body (abdomen/torso) could cause this effect. When walking up stairs, my pre-installed proprioceptive mechanisms were confused at the new weight distribution, such that I would almost fall backwards; I had to relearn briefly how to walk and carry/balance my weight.

What could account for all this? We know and literally SAW something leave my body in drastic amounts--but what was it? After a few hours of guessing, I decided to google into "peritoneal fluid."

Right there, shown in the images, were pictures of bottled peritoneum fluids removed from patients.

It was the exact same color as what I saw in the toilet bowl.

...

Taking these newly-presented facts into consideration now, in conjunction with the previous facts presented about feeling much extremely colder when only minor temperature drops would onset, please reassess your understanding of what may have most likely happened:

(2) Please reexamine the CT scans more closely and carefully, this time with this story and the whole set of facts in mind. How much more likely is it that the cause of everything described is a loss of peritoneal fluid, caused by intestinal-and-peritoneal tear?

(3) If there is any doubt, what singular alternative theory can perfectly account for all factors and events described? [I.e, "peritoneal fluids being dynamic through the course of normal life" may have been a suitable description for the limited information we had in the form of CT images alone, but combined with this story, an alternative hypothesis may need to be placed in.

Images attached, as crude drawings, to show changes in shape and center of gravity (which in nature cannot be changed--any change in fat results in proportional gain or loss throughout the body so as to keep the center of gravity the same; furthermore, it is why our large intestines are shaped in the position of a horseshoe roughly equidistant AROUND the center of gravity point in the abdomen; it is the only way nature can route the tube without allowing for any kind of shifts or disruptions in center of gravity. We know that such a shift is extremely disadvantageous evolutionarily-speaking, and was rooted out a long time ago such that it cannot occur unless you remove pieces of a person's anatomy that aren't meant to be removed.)

I ask again: What explanation best accounts for the sum total of everything we observe in this case?

Thank you.
default
Follow up: Dr. Vivek Chail (0 minute later)
Thank you for your well-thought out reply.

It is a proper answer, that discusses the reality of the uncertainty of peritoneal volumes, as well as their dynamic changes.

While I will continue to ask other Radiologists for their opinions, I find your answer and thought process interesting--I would like to share more details with you, which may potentially change your mind about the nature of the circumstances.

I thank you for the time and energy you've invested, and I thank you as well in advance for your continued interest in my very concerning case.

First of all: Yes--these scans are of my own abdomen.

The reason I framed the question the way I did, is because I wanted to see if the reality of the truth of the scenario can be uncovered from just the comparison of the CT scans alone, without having to stand on additional facts or information related to the circumstances.

However, it seems to me that, in the absence of clarity from a objective radiological diagnostic, I will go in deeper to explain the back story of what has been happening.

Please note: the whole backstory is very long, in short, a kind of chemical/drug poisoning that took place a couple years ago, has radically changed my life, and also produced a downstream cascade of effects and complications, which most recently, have included severe...what we will call "abdominal" issues, though I am extremely certain on my own self-assessment of exactly what is going on. I will cover the most pertinent information at this step--and as our discussion unfolds, I will cover more information, working backwards or "reverse engineering" the scenario, step-by-step, until we arrive at a bird's eye view of the entire problem. The goal will be to build and illustrate a case in which there is enough supporting and circumstantial evidence that it becomes virtually presumptive, with little room for serious or reasonable doubts.

Regarding the fluid dynamism and volume change of the peritoneum: we can accept it to be true that the body is constantly shifting its internal fluid volumes and pressures, in order to always strive towards homeostasis. Our first task, philosophically or investigational at least, is to assess what the normal range of fluctuation would be in a person who does not undergo any radical procedure, accident, or sudden change in medication or health. Imagine a statistical normal distribution curve, where the expected value is the average volume of the peritoneal space--and abdominal volume--of a given man. There is also some standard deviations, within minute to minute, day to day--and with that, over the long term, we have an expectation of what range this person's abdominal volume may change.

The first question, is to evaluate whether the shift from "before" volume to "after" volume is within the normal 2 - 3 standard deviations of the average peritoneal flow for this given person--or for any person, if this person is typical. If the patient himself, who knows his own peritoneal and abdominal size best, would say that "every now and then, though the natural fluctuations of my internal fluids, my peritoneum and abdomen can become this deflated," then it is within the natural course of fluctuations, and radiologists may expect to see such drastic changes within peritoneal volume.

But if it is not...

...If, for example, the patient says, "it was always within this range, and now after the catalyzing event, my peritoneal volume instantly and suddenly became at a level that may easily be....15 or 20 standard deviations below normal....

Then we must assume that some event that is not within the normal flow of homeostasis has transpired; that something clinically significant is afoot.

(1) Any thoughts on this? Also, upon closer inspection, does the volume of change seem within the normal expected range (two or three standard deviations of normal shift), or not?

(2) Are there any medical sources that state how much, or by what percentage, peritoneal fluids may naturally decrease without outside action? We know that fluids may increase via processes related to the onset of ascites--but how often to they decrease, completely on their own?

...

I will resume where I left off with the story:

The mystery event that catalyzed the sudden, drastic change....was an enema.

Allow me to set-up the relevant details.

Firstly, it should be understood, or at least assumed and taken for granted as part of this exercise, that the following factors are at play:

First, I have remained poisoned with a set of drugs/chemicals that, for all intents and purposes, inhibit nociception (pain response & perception, as well as psychological response to pain), reflexes (via lowering of the CNS activity), inflammation capacity, and also very critically, due to CNS suppression, the drug-metabolizing microsomes of the liver has virtually ceased completely in their activity (hence the long term poisoning).

Second, one of the drugs that had more recently been added to the mixture, has been cocaine: cocaine, as a vasoconstrictor, acts very harshly on intestinal tissue when it is there; as a result of remaining within the tissue matrix, unmetabolized cocaine is known medically to produce cases around the world of intestinal ischemias (look up more on this to verify); these ischemias are caused by a kind of "brittle" action, where the cocaine causes the tissues to become not only hard, but extremely rigid and inflexible, like turning a fresh new rubber band into an old one. Intestinal tissue must undergo the highest degree and proportionality of manual stretch within the body, relative to any other tissue; this is why in cases of cocaine use, intestinal ischemias are the first kind that doctors discover.

And, to further point out, take it for granted that this cocaine was present within the body--not just in blood, but mostly in fatty lipid tissue (cell membranes etc), as cocaine has 50x more soluble preference for lipids & fats than for water-based compartments.

...

One day, I decided to do a coffee enema. I had done a few of them before, but this time, I decided I was going to be "extra aggressive" with them. I decided to increase the temperature of the water, and also decided to conduct some new, forceful type of abdominal contractions to pump the water though. In selecting the temperature of the water I decided to use a trick that mothers are known to use, by testing the temperature of the water on the backs of their hands to keep it just below the point that it would sting or burn, in order to keep it within a safe level of warmth. I boiled a pot of coffee, and then eventually did this test; however, what I failed to realize consciously, was that my pain receptors--as a result of both GABA-ergic drug poisoning, as well as strong cocaine presence--were not responsive. I felt the pleasant warmth of the water, which in hindsight, had to have been about 140 - 150 degrees or more.


My insides and colon were virtually empty from a fast I had been doing. I had also just completed an enema with only warm water, to flush out any waste material before hand (of which there was virtually none.) No gas or any other additional features.

I took this coffee, placed it in an enema bucket hung above, and poured it in; pain receptors having been almost completely inactivated for months at this point, I felt no discomfort whatsoever. Additionally, I began pumping extremely vigorously, with my diaphragm muscles, the water throughout my colon--basically initiating a highly dangerous phenomenon known in the engineering as "water hammer"--when the pressure of traveling water within a tube system compounds and builds EXPONENTIALLY at the end site of absorbtive impact, where large damage can often occur in piping systems of any kind due to the changing velocity of water as it is pumped within a system.

They say hindsight is 20/20. However, at that moment, I was determined to rinse my bowels with hot coffee water, all the way until a certain point, that I felt one of the most reverberating sensations of my life, which I both felt inside and heard outside, as a drastic--

--"POP!!!"

...I stop. I slowly get up. I empty out all the waste water--however, what seemed very strange were TWO distinct things that I remember very well: firstly, the volume of liquid coming out seemed to be higher in quantity than the amount I had placed in.

And, secondly, I recall very clearly, smelling the waste water...

--It had an EXTREMELY unique smell, unlike anything I have ever smelled before. The best way I could describe this smell, intuitively, even before I reasoned what this fluid most likely had to be (which took a few hours), would be like the smell of "organ fluid..."

The closest things I have ever smelled to that odor, were the odors that I have smelled whenever my family would buy liver or kidneys to cook and eat, which has happened only a few times in my life--it was a kind of "organ" smell, which does not resemble in any way the smell of intestinal matter nor any smell or taste associated with bile.

Distinct, too, was the *feel* and texture of the liquid. I have done enemas and coffee enemas with water before. I have passed waste many times in my life, each time using toilet paper to separate my fingers from the waste as I wipe, while essentially feeling and taking for granted the texture of the matter.

But this fluid? When I wiped with toilet paper... It felt like no feeling I've ever felt around my anus. It felt like GREASE. It was extremely slick reminding one almost of lubricant gels. Several separate toilet paper wipes were required to de-slick that oily texture off of my anus after releasing that fluid, which felt like a million miles away from anything I've ever felt.

--But different too, as well, was the COLOR of the fluid... For when I finally got up and examined the toilet bowl, not only was the "organ-fluid"-like odor coming up, but the COLOR was different too. It wasn't the color of the yellowish coffee (light roast special for coffee enemas) that I usually see. It wasn't the color of waste matter, of which there was none. it wasn't the color of bile, either, the orange-yellowish color of which I've grown accustomed to seeing very regularly after my liver issues started in 2016, since the poisoning.

It was an extremely distinct hue of color that I've never seen before, that stood out remarkably. It was almost a kind of yellowish-GREEN. Very specific, hard to describe, but knowing it was distinctly and extremely different from anything ever observed.

This, plus the smell, plus the feel, all while knowing this happened after a large POPPING BURST cause by unnaturally high pressure of extremely high-temperature water in my colon, drove me to the conclusion that something may have been pulled from the abdomen that wasn't supposed to be removed.

But what could it have been?

I stood up, went out into the hallway, where my mother was. I was shirtless; she looked at me, stunned, and said "What happened to your belly?"

I stood in profile, and looked at myself in the mirror.

About several pounds worth of volume were gone--to the point of looking unnatural. At my lowest weight in my life many years ago, I never had my abdomen dip below/behind my ribs so as to have them stick out--and yet, here they were. Additionally, not only was the thickness of my abdomen drastically reduced--but my rib cage, too, was NOTICEABLY THINNER. My rib cage--which, in all my adult life, has never suddenly changed in thickness. That would be impossible.

It looked like someone took a large piece of mass out of my belly--as if someone did instantaneous surgery and removed tremendous amounts of three-dimensional volume from my entire torso.

I stepped on a scale. Surely enough, I weighed SEVERAL pounds less than I did the prior evening. Blood pressure was at 100, which is 30 points below my consistent level.

There was one other stand-out feature, too. I am a personal trainer, and know my body very well--my balance when moving and walking, and things of that nature. I know and feel it very well, and very accurately. However, upon standing up and walking after the enema pop, my own CENTER OF GRAVITY shifted--both DOWN, and towards the rear.

Only a removal of volume from the front part of the upper body (abdomen/torso) could cause this effect. When walking up stairs, my pre-installed proprioceptive mechanisms were confused at the new weight distribution, such that I would almost fall backwards; I had to relearn briefly how to walk and carry/balance my weight.

What could account for all this? We know and literally SAW something leave my body in drastic amounts--but what was it? After a few hours of guessing, I decided to google into "peritoneal fluid."

Right there, shown in the images, were pictures of bottled peritoneum fluids removed from patients.

It was the exact same color as what I saw in the toilet bowl.

...

Taking these newly-presented facts into consideration now, in conjunction with the previous facts presented about feeling much extremely colder when only minor temperature drops would onset, please reassess your understanding of what may have most likely happened:

(2) Please reexamine the CT scans more closely and carefully, this time with this story and the whole set of facts in mind. How much more likely is it that the cause of everything described is a loss of peritoneal fluid, caused by intestinal-and-peritoneal tear?

(3) If there is any doubt, what singular alternative theory can perfectly account for all factors and events described? [I.e, "peritoneal fluids being dynamic through the course of normal life" may have been a suitable description for the limited information we had in the form of CT images alone, but combined with this story, an alternative hypothesis may need to be placed in.

Images attached, as crude drawings, to show changes in shape and center of gravity (which in nature cannot be changed--any change in fat results in proportional gain or loss throughout the body so as to keep the center of gravity the same; furthermore, it is why our large intestines are shaped in the position of a horseshoe roughly equidistant AROUND the center of gravity point in the abdomen; it is the only way nature can route the tube without allowing for any kind of shifts or disruptions in center of gravity. We know that such a shift is extremely disadvantageous evolutionarily-speaking, and was rooted out a long time ago such that it cannot occur unless you remove pieces of a person's anatomy that aren't meant to be removed.)

I ask again: What explanation best accounts for the sum total of everything we observe in this case?

Thank you.
doctor
Answered by Dr. Vivek Chail (2 days later)
Brief Answer:
Osmotic movement of fluids is a possible theory to account for fluid loss

Detailed Answer:
Hi,
Thanks for writing back with an update.

After viewing the images carefully, there is certainly a decrease in the abdominal diameter.

Technically speaking, I would like to highlight an area of mismatch between the 2 scans. In the previous CT scan the urinary bladder is well distended and in the recent CT scan we see a partially distended urinary bladder. I would have chosen to do both the scans with similar distention of the urinary bladder for a better comparison.

Coming back to the reasoning part for the loss of fluids following coffee enema procedure, it is important to know that during coffee enema osmotic movement of electrolytes and water molecules takes place in the luminal mucosa of the large bowel and it can cause sudden movement of fluids from the internal parts of the body to the colon and that is a possible cause for the elimination of large quantities of fluids.

Coffee enema is known to cause decreased pain perception in people suffering from pain due to cancer. Therefore it is less likely that even movement of significant amount of fluids into the colon will cause any pain and also your pain perception is decreased and so you might not have felt pain and discomfort.

Regards,
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Vivek Chail (0 minute later)
Brief Answer:
Osmotic movement of fluids is a possible theory to account for fluid loss

Detailed Answer:
Hi,
Thanks for writing back with an update.

After viewing the images carefully, there is certainly a decrease in the abdominal diameter.

Technically speaking, I would like to highlight an area of mismatch between the 2 scans. In the previous CT scan the urinary bladder is well distended and in the recent CT scan we see a partially distended urinary bladder. I would have chosen to do both the scans with similar distention of the urinary bladder for a better comparison.

Coming back to the reasoning part for the loss of fluids following coffee enema procedure, it is important to know that during coffee enema osmotic movement of electrolytes and water molecules takes place in the luminal mucosa of the large bowel and it can cause sudden movement of fluids from the internal parts of the body to the colon and that is a possible cause for the elimination of large quantities of fluids.

Coffee enema is known to cause decreased pain perception in people suffering from pain due to cancer. Therefore it is less likely that even movement of significant amount of fluids into the colon will cause any pain and also your pain perception is decreased and so you might not have felt pain and discomfort.

Regards,
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Vivek Chail (6 hours later)
Dr Chail,

I am glad that you have replied. I am grateful for the time and energy of yours dedicated to examining my case and its material more closely and with more extensive thought.

At the very least, it is one of those kinds of cases that piques the interest and curiosity of those who have a love of medicine and science. While this, along with the other various aspects of my complex case that I have not covered in our conversation, have been concerning (if not outright distressing) to live with during the past several months to couple years, it is also something that we are all very interested in working out and fascinated in seeing how it can be solved--as well as what the real truths are, working it out like a puzzle.

That being said, I must state at the outset of any further conversation, that from the point of the occurrence of this, till the present day, I have remained not just sure, but extremely certain beyond any reasonable doubt on my own level, and as a result of my own experience and analysis, that the reality of my case is not any different than ohw I have implicated it to be in communication with you, my own primary care doctor, and others in my life.

However, while being sure is often a critical factor in life itself, it often is not enough in science and medicine. Even though we possess, in truth, a countless number of neurons with such complex and unimaginative deep and elaborate neural networks connected to our awareness, our experience of life, and our gut ganglia--our "intuition," we still, in the polliticized world of science and medicine, must act out the presumptions that that which cannot be proven must be cast, with cynicism, to remain in doubt. For myself, I am reminded of the famous celebrity murder case we had here in the US in the 1990's, with OJ Simpson. Everybody involved in the case, as well as the general public of our country, all "knew" he did it. But because everything presented had a second "possible" explanation, the legal world "officially" made the assumption that, most likely, was not in accordance with reality.

It is similar to the position I find myself in, in a kind of way. The truth of the experience that I have lived, along with my accurate awareness of what has transpired, results in a conclusion that I have survived a critical and dangerous event that can continue to manifest downstream complications unless those who own or manage the resources needed to fix my problem are brought to be seen with me.

In problems of engineering, literature, other fields within the sciences, among other areas of life, scientific thought, cynicism, and the whole kind of procedural and rational or logical caution, is a hallmark of society most healthy and beneficial for the integrity of those fields, as well as for the gifts they produce. However, when dealing with medicine, we come across a kind of dilemma: we are dealing with human beings--with people and with real lives, which we hold more sacred and valuable above anything else; people who MAY possibly be hurt, who may depend on emergency care in order to have their potentially very-time-sensitive issues from getting worse in way that are unpredicatable at the outset. Only hindsight is 20/20.

My mother, who used to work at a hospital for almost 20 years, has seen countless stories of patients who have walked in with some of the most outlandish, crazy and unbelievable kinds of stories. They sought help from doctors, who, being trained n a very systematic way that is virtually uniform in the medical world, dismissed the assumptions or claims of the patients as a result of either lack of glaring proof that was outwardly observable or testable by the doctor with limits of present-day technology, or just a lack of convention or "probable likeliness" that something like their case could manifest, when looking at the world from a rigid, text-book kind of view.

Why would my mom tell me all of these stories over the years while I was growing up? Because a much *higher* proportion of those cases than the doctors in those situations would like to admit, the doctors end up getting it wrong, and the patients? They were right all along. Except in their case, the time lost and complications gained before the truth was discovered were potentially avoidable, within a system with an altered philosophy: one that places a higher regard for the superiority of the self-intuitive powers of the neural networks within the patients themselves. Maybe one day, many years from now, the world will be lucky to experience that shift.

...

Anyway, as for our conversation and assessment, from a radiological and medical point of view, you are doing a good and thorough work of pointing out any possible discrepancies.

A couple things for us to do--one of them will be to go back and analyze the points, another, we will introduce more set of facts: namely, a bit more backstory, as well as more story and facts of what have happened since the enema (in March of this past year), that may offer further evidence to support my position through the philosophical and logical trials it has had to endure. But, before that, I will quickly add two extra points of notes that, in rushing through my previous message to you a couple days ago, I forgot to include.

The following should be added to the information of the previous message, that had not been placed there.

- " ... To note: The reason that I suspected that the material suspected to be peritoneal fluids was able to leave my body system completely, and result in a significant net loss of body volume, is because of the simultaneous presence and dynamics or force of the enema water irrigating the physical area. it may be reasoned that, in cases of other peritoneal tears, it may often be the case that, once the peritoneal fluids burst out of their membranes and fill into the empty, cavernous tubes of the gastrointestinal tract, they may relatively quickly, in turn, be reabsorbed locally at the intestinal walls, and the volume brought back into systemic retainment.

- " ... One other strange occurrence that took place, after I found the reduction of abdominal volume that day. Normally, nearly every day for the past few years, I have been doing a set of specific physical exercises, some of the yoga-like in their nature. I have been doing these exercises everyday, while practically meditating through the movements and in the postures, and know both my body and its feelings and balances extremely well, in terms of what is typical or not typical.

When I got into upward dog posture about an hour after the loss of abdominal volume, I was doing the move out of habit, not so much as to see or intentionally discover any additional features of my present condition that are out of normal. While my torso upward, all felt as it should have. However, when I interted my torso (which is long and skinny) nearly completely upside-down into the downward dog position, I was shocked by a sudden sensation that, prior to feeling it, I would not have even ever believed could be possible.

It was the sensation of literally the entire bundle of internal organs all of a sudden shifting, as they could be felt SLIDING up from my lower-mid belly INTO MY CHEST CAVITY and up to the ribs...!!!

I could not believe what I was feeling. Very quickly, I realized intuitively what had to be the only explanation for this. I confirmed what I was feeling as I reverted back to an upward position: momentarily, the bundle of organs could be felt, once again, slowly gliding back down to the original position in the belly. Nothing like this was ever felt before--not as the result of any one of the enemas I have ever done before (nor read about, that could ever be reported as causing such a phenomenon), nor as a result of torso inversion during any other exercise situation.

I realized quickly that it was must like in the case of mailing, shipping or receiving a package or box, where the contents within the box are smaller than the box itself. However, in th case where there are large *air packets* placed all around the product, then the product will not shift around within the box due to the presence of the air-pressured packets within the box, effectively immobilizing it.

The same is true of our organs. The internal peritoneal sacs, packed full and pressured with plenty of peritoneal fluids, are blown up to the point that they keep pressure on the other organs such that they are not able to shift around loosely within the abdominal cavity. Maintaining perpetually at this state would be the maintenance of homeostasis. Organs sliding up and down is yet another piece of evidence suggesting a direct decrease of peritoneal volume, which following something as an aggressive hot-water enema (which are known to cause intestinal tears in even normal population) into intestinal tissue already saturated with the vasoconstrictive drug cocaine (which is already known to heavy promote intestinal tears), all the factors line up nearly perfectly."

...

Let's proceed to examine the points present in your reply.

I agree that it may be at least slightly more ideal to have emptied the bladder before both CT scans, than to have a slight mismatch.

However, I also believe that the mismatch between bladder volume would, for all practical purposes, not affect the reading at any other area. It should not affect our ability to discern overall abdominal or peritoneal size differences, largely because any volume change at the bladder tends to stay localized at that part of the body, as the pressure of its contents disperses as we pan out. A full versus empty bladder, for example, might raise the overall lower abdominal wall by a good millimeter or two, but it certainly could have no effect on increasing of decreasing upper torso thickness as drastically as we see on these scans.

Proceeding to the matter of diffusion and osmosis across intestinal membranes--yes, it is indeed true that osmosis does occur across the membranes here. However, the colon is known as the dry intestine, chiefly due to the fact that generally speaking, fluids of a regular nature tend to move away from the internal compartment of the colon, and into systemic absorption. The reason for this may go beyond passive osmosis; however, looking at the issue at this level only, one of the first things we understand about it is that fluids of a less dense or less electrolyte- or solute-rich constitution will absorb electrolytes from without, while trading "relative water" back out, by having it osmote away.

The fluids of the body are extremely mineral- and electrolyte-rich, with systemic fluid and blood profiles nearly comparable to, or isotonic with, sea water--according to some. However, distilled water that is cooked with a bit of coffee does not come nearly as close on the saturation gradient in terms of solution density; as a result, the distilled coffee enema water would not attract more water to itself across membranes from fluids rich in electrolytes. Instead, the net exchange would be of minerals diffused towards the enema water, with enema water becoming systemically absorbed.

This theory matches well with the experience of reality, as those of us who engage in coffee enemas know that our intestines absorb the water and fluid, with less coming out at the end than the amount originally coming in. To this law of physics there can be no reversal or opposing force.

It is relatively rare to ingest or use fluids n cases where the contents brought into the colon are hypertonic relative to the body's minerals. One of those exceptions would be the high of high aounts of magnesium sulfate (Epsom salt), travelling through the intestines. it is one of the few examples that could lead to a reversal of net fluid exchange such that fluids passively osmote into the intestines to accumulate, instead of being drawn out of. However, the amount of time it takes for this osmosis to manifest significant amount of water, from the time of initiation, is considerable; it wouuld take at least many minutes for a sizeable amount of water to accummulate. If it were, the fluid would retain the typical profile of diuretic-induced waste water (with no neon-green fluid matching peritoneal fluid in appearance and no smell), as only solvents (fluids) can osmote; solutes, on the other hand, are what diffuse.

It would take much longer than the time span of about several seconds - 30 seconds, which was the time frame of the enema, through the pop, and back out to immediate dumping. If coffee enemas were ever, completely alone on their own power, to remove water from the body and from systemic or abdominal fluid storage at such drastic rates as to cause long-term torso- and upper-trunk thinning as drastic as what we see in my case, it would have been on the front page of every paper around the world already.

...

In regards to coffee enemas diminishing the feeling of pain, it is an interesting fact to note. It does happen to be the case that I felt little to no pain during this transpired event--although the reverberations of the bursting, popping sensation were felt.

Coffee enema water may or may not have played a role in the decrease of pain for that particular instance. However, it is important to note that, having had multiple agents in my system over the course of time that have reduced the perception to beyond a threshold so vastly large, that nearly nothing is able to cause it.

...
[I will, to provide a little bit of more relevant background information, discuss why this is the case. I will briefly reveal more about what started a devastating series of events for me. This is not extremely dircetly related to the tear--but it is a parent cause of what we see today, as none of these intestinal issues would have happened if it were not for what is described in the following article (and I will explain exactly how this is so):

https://www.heighpubs.org/jcicm/pdf/jcicm-aid1001.pdf

The subject described here is me. I am the first person in medical history to try this combination of substances/drugs, to a point that I accidentally ended up in a coma.

What the hospital that discharged me didn't realize, is that Phenibut's pro-GABA action, potentiated by Fasoracetam's systemic GABA-B receptor-upregulating effect, caused such a draastic lowering of the nervous system/electrical activity of the Central Nervous System, that the drug-metabolizing microsomes of the liver stopped metabolizing the drugs, and essentially all contents of the circulatory system. (This same high-GABA effect is known to happen with high amount of barbiturates, which was one of the reasons they were eventually replaced altogether as a class of medicine.) The only reason I "woke up," seemingly leveled off by mere outward appearance and still walk around today, is due to apparent onset of tolerance, along with the fact that Phenibut, unlike any currently-existing drug in the Western pharmacopeia, is a GABAergic AND a pro-dopamine STIMULANT at once.

Further down the line, months later, with Phenibut + Fasoracetam suppressing my drug-metabolization over the long-term I would find that taking a recreational drug dose of MDMA at a party here in my country would, instead of lasting for the typical 2 or 3 hours, last for 2 weeks. Cocaine taken into my system has been present for 13 months, and I taste it everyday as it continues to numb my mucous membranes, as it recirculates. To this day, everytime I exert myself even moderately, or do anything to initiate lipolysis or fat-burning of even the slightest degree, a massive release of drug substannce comes back out into circulation and into the nervous system, as it all goes around and around. It has made my life a nightmare.

It blows my mind how I go to doctors in this country with a very clear problem, and a very clear proposed solution (charcoal-based hemoperfusion to adsorb the chemicals out of my circulation), and they basically act like they have no idea whats going on and have no idea what to do. Feels like I'm left to suffer because of complete systemic professional incompetence... But that's just this country, I think.

And, to connect the dots all the way around, as soon as I took the cocaine, it saturated my lipids and tissues, skin turned from baby soft to rock hard and lost all elasticity, especially at the feet) for months, all while pains and tears within my GI tract have been reliably identified--by my own self--which are known to be caused in some cases whenever cocaine is applied to the intestines via systemic absorption from ingestion, and large-enough amounts are allowed to accumulate there without being biotransformed into safer metabolites quickly enough).

One of the chief difficulties with Phenibut isn't just that it is an extremely strong antinociceptive (pain-eliminating) drug, as verified in studies and real user experience--it also, with fasoracetam and even more so now recently following the addition of cocaine, completely disables the inflammatory signalling and potential of the body. This makes it extremely hard for serious problems to show visible, inflammation-process-based manifestations of CT scans to allow radiologists to make positive readings.

To serve as a medically-verified instance of this, my pulmonologist found me to have three serious live infections of heavy growth within my lungs through sputum tests--but my chest X-Ray before th visit showed completely "negative" (false negative), due to local tissues not responding to the infections by turning on inflammation process. He told me that in 40 years of practice he's never seen something quite like this...!!

This same neurological suppression, too is what has kept my liver turned off, unable to breakdown these drugs out of my body and out of my life.]
...

Now, coming back to the relevant matter at hand...

The osmosis theory may have been our best attempt to explain one of the symptoms that I have reported, namely the expulsion and loss of fluid. However, as investigators, we must assess whether this one explanation accounts for, and explains, all variables and symptoms presented. Osmotic flowing of fluids not only may not be accounting for the fluid accumulation/expulsion witnessed, it may also not be enough, standing alone, to explain the entire set of symptoms outlined, which include--

- several pounds of systemic weight (non-waste-matter) lost instantaneously, resulting in drastic and apparent volume reduction extremely far beyond the ranges of normal;

(1) a 30-point drop in pressure to 100 that stayed consistently lowered for at least weeks;

(2) becoming extremely cold, as if by sudden lack of vital insulation, in temperatures far above what I am normally very comfortable in;

(3) the experience of organs sliding;

(4) a drastic sudden shift of center of gravity that remained;

This just outlines the first symptoms. What has happened since then?

(5) As would be expected with opened intestinal and peritoneal tissues, within weeks I started to feel sensations of infectious stinging developing within my lower abdomen and pelvic floor. This was not only felt internally, but also perceived externally: both my family and friends, as well as I, started smelling what was like the *SMELL OF DEAD, ROTTING FISH*, coming from the flesh around my lower belly. Showering aggressively with many soaps did not resolve the issue, as 30 minutes after the shower, the flesh around the lower belly would re-saturate with that disgusting fish smell.

Eventually, the pain spread to my testicles, which, after a lifetime of hanging in one specific position, eventually felt ripping, stinging sensations during one night, where I witnessed them "dislodge" and suddenly now hang in a drastically different position, with completely different rotation, and drastically looser and lower, ever since then; it seems that the infection destroyed the connective or supporting structures that keep the testicular glands tethered to their attachments within the lower pelvis.

Because Phenibut blocks inflammation and more pronounced perception of psychologically-apparent pain, no doctor could get a positive "scan" on anything. Simple spoken facts of the extreme danger and emergency status of my case fell on deaf ears. Eventually, i was able to get one doctor to agree to prescribe me zero-order antibiotics, which, after combining them with nanosilver solution (increases the effectiveness of antibiotics by 10,000 times as per studies), both the infectious stinging and the fish smell went away after a few days.

--Purely theoretically-speaking. If the intestinal and peritoneal membrane would not have been perforated. Then it is reasonable to expect that such an infection in the very days and weeks after, would not have happened. Bacteria aren't able to cross thru the intestinal membrane en masse unless there is some serious problem. This is almost common sense.

(6) Was this enema-induced tear the only tear? No. Sadly, as a result on ongoing tissue brittleness and cocaine saturation, multiple other tears have manifested in different parts of my GI tract. The one caused by the enema I didn't have to worry as much about in terms of food and beverages, as they would be absorbed to the fullest degree possible before they reach the large intestine. However, in the case of more recent teaars in the earlier parts of the small intestine (of unknown cause or catalyst), I have, for the last six of seven months (since about May), been consuming food and ingesting beverages that, within one or two minutes, end up sitting on my pelvic floor on top of my prostate and around my organs.

This is no exaggeration. I can take a cup of ice cold water, drink it quickly--and within a minute, I feel sudden ice-cold sensation pooling up around my prostate, around the outside or reverse side of the internal anal sphincter rim, and my scrotum becomes about 10 degrees colder instantaneously.

If I eat ginger, I feel that classic ginger sting on my prostate and pelvic floor tissues about 1 - 2 minutes later. If I drink coffee that is brewed to be very acidic, I will feel the acid tingling there in the way only an acid can. If I eat crunchy, hard-shelled tacos or chips, and DON'T CHEW WELL before I swallow, I will feel the chip corners poking me all around the pelvic floor and the *reverse* side of the end of my colon.

This serves as further evidence that my peritoneal space has been infiltrated. In a sane society, a story like this would be grounds for immediate emergency treatment, exploratory surgery and eventually fixing whatever's there, with smart doctors realizing that at the root of all these complications is a systemic drug poisoning that just MAY BE possible to resolve using currently existing technology (charcoal-base hemoperfusion / M.A.R.S.) to extract the drugs back out of the body.

But everytime I go to the ER or any hospital about this, they see no inflammation, no pain. They fill me with another 100 X-Rays worth of radiation by means of another CT scan, and see no inflammation--nothing unremarkable, except for "apparent bladder wall thickening," which doesn't make sense and they can't understand why it's there. I explain to them that it's not bladder wall thickening, it's all the stuff I've been eating piling up in there. But their brains turn off, they refuse to proceed beyond anything if the CT scan is negative, and they force me to get discharged. It's like they are robots, that can't think accurately enough to perceive the reality of what is happening directly in front of them.

I have lost my faith in this system.

...

To suspect other causes in a prudent manner may be one thing, when a clinician has not yet beheld all the facts. But in my case here, doctors and ER staff have seemingly no interest in reading of hearing anything about my case. They have very regimented thinking: "No I can't read anything about this. If it's anything that we can't treat today, you just need to talk to your primary doctor about it. And, we can't do anything because the CT says negative and we have no further capacity to hear other details about this complex case." It's like they don't want to know. This puts me in the worst position one can be in.

A bit of old ancient wisdom--a proverb: "You know a thing by its effects."

We see the effects--so what is the thing?

...

Are we able to rule out peritoneal tear and infiltration by this point in time? Is it the most likely suspected explanation for what we are seeing, now that we continue to see more and more about my case?

Please forgive me for the lack of details in my earlier messages. This dialogue with you has been very valuable to me, as it allows the opportunity to practice to present my case. Like I said earlier, I KNOW what the truth is, in advance of me writing this. I have chosen to release information slowly to test where is the logical tipping is in others hearing this, who are not already acquainted with my case.

Before I close, I'll offer a story from one of the articles and reports about cocaine-induced intestinal ischemias. Generally, they are fatal about 20 percent of the time.

One particular story, the patient comes in, ER doc sees he has abdominal pain. The patient is having an immune reaction, plus there is inflammation in his belly causing distention. CT scan, however, fails to find any free intraperitoneal air, which often is the only sign. To specify, there was no inflammation or "damage" visible in any of the intestinal tissues.

Any doc with this information would have said "It's just XYZ, CT scan is negative so it's probably nothing, we're sending you home now." But this particular doctor asked additional questions to probe about the patient's drug use. The patient finally admitted that he had taken cocaine recently.

Again, any typical doctor with this information still would not have connected the dots. ("Cocaine, okay so what. Every third person coming in here practically has got drugs in their system.") But this doctor had the right hunch--he established a high-degree of "clinicial suspicion." He made the decision to engage in immediate emergency exploratory laparotomy--an admittedly bold move to cut some open because of belly pain with prior coke use, especially with a negative CT scan.

What did the doctor find? Gangrenous intestinal material all throughout.

His hunch was right: it was cocaine-induced ischemia.

...

I need a doctor of this type of caliber. Fortunately for the doctor and the patient, the patient's body was showing normal signs of inflammation and immune reaction. However, if that were me in his shoes with the exact problem--now it looks like a guy complaining of belly pain with a comparably negative CT scan (it is somewhat typical for CT scans of cocaine-induced damage to appear negative), who also had no distention, no fever. No immune markers. I can explain that other doctors of mine have found the low inflammatory markers and low immune response in the presence of serious infections, but they either cannot, or are emotionally or psychologically unwilling to, process all this information in a way that proves their initial assumptions wrong.

I'm in a difficult spot. I hope that your professional opinion can restore some confidence of mine in medicine.

Please let me know if the facts, taken together as a whole for yourself now, Doctor, are painting an entirely different (and hopefully more clearly accurate and even obvious) picture for you know.

Thank you so much.
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Follow up: Dr. Vivek Chail (0 minute later)
Dr Chail,

I am glad that you have replied. I am grateful for the time and energy of yours dedicated to examining my case and its material more closely and with more extensive thought.

At the very least, it is one of those kinds of cases that piques the interest and curiosity of those who have a love of medicine and science. While this, along with the other various aspects of my complex case that I have not covered in our conversation, have been concerning (if not outright distressing) to live with during the past several months to couple years, it is also something that we are all very interested in working out and fascinated in seeing how it can be solved--as well as what the real truths are, working it out like a puzzle.

That being said, I must state at the outset of any further conversation, that from the point of the occurrence of this, till the present day, I have remained not just sure, but extremely certain beyond any reasonable doubt on my own level, and as a result of my own experience and analysis, that the reality of my case is not any different than ohw I have implicated it to be in communication with you, my own primary care doctor, and others in my life.

However, while being sure is often a critical factor in life itself, it often is not enough in science and medicine. Even though we possess, in truth, a countless number of neurons with such complex and unimaginative deep and elaborate neural networks connected to our awareness, our experience of life, and our gut ganglia--our "intuition," we still, in the polliticized world of science and medicine, must act out the presumptions that that which cannot be proven must be cast, with cynicism, to remain in doubt. For myself, I am reminded of the famous celebrity murder case we had here in the US in the 1990's, with OJ Simpson. Everybody involved in the case, as well as the general public of our country, all "knew" he did it. But because everything presented had a second "possible" explanation, the legal world "officially" made the assumption that, most likely, was not in accordance with reality.

It is similar to the position I find myself in, in a kind of way. The truth of the experience that I have lived, along with my accurate awareness of what has transpired, results in a conclusion that I have survived a critical and dangerous event that can continue to manifest downstream complications unless those who own or manage the resources needed to fix my problem are brought to be seen with me.

In problems of engineering, literature, other fields within the sciences, among other areas of life, scientific thought, cynicism, and the whole kind of procedural and rational or logical caution, is a hallmark of society most healthy and beneficial for the integrity of those fields, as well as for the gifts they produce. However, when dealing with medicine, we come across a kind of dilemma: we are dealing with human beings--with people and with real lives, which we hold more sacred and valuable above anything else; people who MAY possibly be hurt, who may depend on emergency care in order to have their potentially very-time-sensitive issues from getting worse in way that are unpredicatable at the outset. Only hindsight is 20/20.

My mother, who used to work at a hospital for almost 20 years, has seen countless stories of patients who have walked in with some of the most outlandish, crazy and unbelievable kinds of stories. They sought help from doctors, who, being trained n a very systematic way that is virtually uniform in the medical world, dismissed the assumptions or claims of the patients as a result of either lack of glaring proof that was outwardly observable or testable by the doctor with limits of present-day technology, or just a lack of convention or "probable likeliness" that something like their case could manifest, when looking at the world from a rigid, text-book kind of view.

Why would my mom tell me all of these stories over the years while I was growing up? Because a much *higher* proportion of those cases than the doctors in those situations would like to admit, the doctors end up getting it wrong, and the patients? They were right all along. Except in their case, the time lost and complications gained before the truth was discovered were potentially avoidable, within a system with an altered philosophy: one that places a higher regard for the superiority of the self-intuitive powers of the neural networks within the patients themselves. Maybe one day, many years from now, the world will be lucky to experience that shift.

...

Anyway, as for our conversation and assessment, from a radiological and medical point of view, you are doing a good and thorough work of pointing out any possible discrepancies.

A couple things for us to do--one of them will be to go back and analyze the points, another, we will introduce more set of facts: namely, a bit more backstory, as well as more story and facts of what have happened since the enema (in March of this past year), that may offer further evidence to support my position through the philosophical and logical trials it has had to endure. But, before that, I will quickly add two extra points of notes that, in rushing through my previous message to you a couple days ago, I forgot to include.

The following should be added to the information of the previous message, that had not been placed there.

- " ... To note: The reason that I suspected that the material suspected to be peritoneal fluids was able to leave my body system completely, and result in a significant net loss of body volume, is because of the simultaneous presence and dynamics or force of the enema water irrigating the physical area. it may be reasoned that, in cases of other peritoneal tears, it may often be the case that, once the peritoneal fluids burst out of their membranes and fill into the empty, cavernous tubes of the gastrointestinal tract, they may relatively quickly, in turn, be reabsorbed locally at the intestinal walls, and the volume brought back into systemic retainment.

- " ... One other strange occurrence that took place, after I found the reduction of abdominal volume that day. Normally, nearly every day for the past few years, I have been doing a set of specific physical exercises, some of the yoga-like in their nature. I have been doing these exercises everyday, while practically meditating through the movements and in the postures, and know both my body and its feelings and balances extremely well, in terms of what is typical or not typical.

When I got into upward dog posture about an hour after the loss of abdominal volume, I was doing the move out of habit, not so much as to see or intentionally discover any additional features of my present condition that are out of normal. While my torso upward, all felt as it should have. However, when I interted my torso (which is long and skinny) nearly completely upside-down into the downward dog position, I was shocked by a sudden sensation that, prior to feeling it, I would not have even ever believed could be possible.

It was the sensation of literally the entire bundle of internal organs all of a sudden shifting, as they could be felt SLIDING up from my lower-mid belly INTO MY CHEST CAVITY and up to the ribs...!!!

I could not believe what I was feeling. Very quickly, I realized intuitively what had to be the only explanation for this. I confirmed what I was feeling as I reverted back to an upward position: momentarily, the bundle of organs could be felt, once again, slowly gliding back down to the original position in the belly. Nothing like this was ever felt before--not as the result of any one of the enemas I have ever done before (nor read about, that could ever be reported as causing such a phenomenon), nor as a result of torso inversion during any other exercise situation.

I realized quickly that it was must like in the case of mailing, shipping or receiving a package or box, where the contents within the box are smaller than the box itself. However, in th case where there are large *air packets* placed all around the product, then the product will not shift around within the box due to the presence of the air-pressured packets within the box, effectively immobilizing it.

The same is true of our organs. The internal peritoneal sacs, packed full and pressured with plenty of peritoneal fluids, are blown up to the point that they keep pressure on the other organs such that they are not able to shift around loosely within the abdominal cavity. Maintaining perpetually at this state would be the maintenance of homeostasis. Organs sliding up and down is yet another piece of evidence suggesting a direct decrease of peritoneal volume, which following something as an aggressive hot-water enema (which are known to cause intestinal tears in even normal population) into intestinal tissue already saturated with the vasoconstrictive drug cocaine (which is already known to heavy promote intestinal tears), all the factors line up nearly perfectly."

...

Let's proceed to examine the points present in your reply.

I agree that it may be at least slightly more ideal to have emptied the bladder before both CT scans, than to have a slight mismatch.

However, I also believe that the mismatch between bladder volume would, for all practical purposes, not affect the reading at any other area. It should not affect our ability to discern overall abdominal or peritoneal size differences, largely because any volume change at the bladder tends to stay localized at that part of the body, as the pressure of its contents disperses as we pan out. A full versus empty bladder, for example, might raise the overall lower abdominal wall by a good millimeter or two, but it certainly could have no effect on increasing of decreasing upper torso thickness as drastically as we see on these scans.

Proceeding to the matter of diffusion and osmosis across intestinal membranes--yes, it is indeed true that osmosis does occur across the membranes here. However, the colon is known as the dry intestine, chiefly due to the fact that generally speaking, fluids of a regular nature tend to move away from the internal compartment of the colon, and into systemic absorption. The reason for this may go beyond passive osmosis; however, looking at the issue at this level only, one of the first things we understand about it is that fluids of a less dense or less electrolyte- or solute-rich constitution will absorb electrolytes from without, while trading "relative water" back out, by having it osmote away.

The fluids of the body are extremely mineral- and electrolyte-rich, with systemic fluid and blood profiles nearly comparable to, or isotonic with, sea water--according to some. However, distilled water that is cooked with a bit of coffee does not come nearly as close on the saturation gradient in terms of solution density; as a result, the distilled coffee enema water would not attract more water to itself across membranes from fluids rich in electrolytes. Instead, the net exchange would be of minerals diffused towards the enema water, with enema water becoming systemically absorbed.

This theory matches well with the experience of reality, as those of us who engage in coffee enemas know that our intestines absorb the water and fluid, with less coming out at the end than the amount originally coming in. To this law of physics there can be no reversal or opposing force.

It is relatively rare to ingest or use fluids n cases where the contents brought into the colon are hypertonic relative to the body's minerals. One of those exceptions would be the high of high aounts of magnesium sulfate (Epsom salt), travelling through the intestines. it is one of the few examples that could lead to a reversal of net fluid exchange such that fluids passively osmote into the intestines to accumulate, instead of being drawn out of. However, the amount of time it takes for this osmosis to manifest significant amount of water, from the time of initiation, is considerable; it wouuld take at least many minutes for a sizeable amount of water to accummulate. If it were, the fluid would retain the typical profile of diuretic-induced waste water (with no neon-green fluid matching peritoneal fluid in appearance and no smell), as only solvents (fluids) can osmote; solutes, on the other hand, are what diffuse.

It would take much longer than the time span of about several seconds - 30 seconds, which was the time frame of the enema, through the pop, and back out to immediate dumping. If coffee enemas were ever, completely alone on their own power, to remove water from the body and from systemic or abdominal fluid storage at such drastic rates as to cause long-term torso- and upper-trunk thinning as drastic as what we see in my case, it would have been on the front page of every paper around the world already.

...

In regards to coffee enemas diminishing the feeling of pain, it is an interesting fact to note. It does happen to be the case that I felt little to no pain during this transpired event--although the reverberations of the bursting, popping sensation were felt.

Coffee enema water may or may not have played a role in the decrease of pain for that particular instance. However, it is important to note that, having had multiple agents in my system over the course of time that have reduced the perception to beyond a threshold so vastly large, that nearly nothing is able to cause it.

...
[I will, to provide a little bit of more relevant background information, discuss why this is the case. I will briefly reveal more about what started a devastating series of events for me. This is not extremely dircetly related to the tear--but it is a parent cause of what we see today, as none of these intestinal issues would have happened if it were not for what is described in the following article (and I will explain exactly how this is so):

https://www.heighpubs.org/jcicm/pdf/jcicm-aid1001.pdf

The subject described here is me. I am the first person in medical history to try this combination of substances/drugs, to a point that I accidentally ended up in a coma.

What the hospital that discharged me didn't realize, is that Phenibut's pro-GABA action, potentiated by Fasoracetam's systemic GABA-B receptor-upregulating effect, caused such a draastic lowering of the nervous system/electrical activity of the Central Nervous System, that the drug-metabolizing microsomes of the liver stopped metabolizing the drugs, and essentially all contents of the circulatory system. (This same high-GABA effect is known to happen with high amount of barbiturates, which was one of the reasons they were eventually replaced altogether as a class of medicine.) The only reason I "woke up," seemingly leveled off by mere outward appearance and still walk around today, is due to apparent onset of tolerance, along with the fact that Phenibut, unlike any currently-existing drug in the Western pharmacopeia, is a GABAergic AND a pro-dopamine STIMULANT at once.

Further down the line, months later, with Phenibut + Fasoracetam suppressing my drug-metabolization over the long-term I would find that taking a recreational drug dose of MDMA at a party here in my country would, instead of lasting for the typical 2 or 3 hours, last for 2 weeks. Cocaine taken into my system has been present for 13 months, and I taste it everyday as it continues to numb my mucous membranes, as it recirculates. To this day, everytime I exert myself even moderately, or do anything to initiate lipolysis or fat-burning of even the slightest degree, a massive release of drug substannce comes back out into circulation and into the nervous system, as it all goes around and around. It has made my life a nightmare.

It blows my mind how I go to doctors in this country with a very clear problem, and a very clear proposed solution (charcoal-based hemoperfusion to adsorb the chemicals out of my circulation), and they basically act like they have no idea whats going on and have no idea what to do. Feels like I'm left to suffer because of complete systemic professional incompetence... But that's just this country, I think.

And, to connect the dots all the way around, as soon as I took the cocaine, it saturated my lipids and tissues, skin turned from baby soft to rock hard and lost all elasticity, especially at the feet) for months, all while pains and tears within my GI tract have been reliably identified--by my own self--which are known to be caused in some cases whenever cocaine is applied to the intestines via systemic absorption from ingestion, and large-enough amounts are allowed to accumulate there without being biotransformed into safer metabolites quickly enough).

One of the chief difficulties with Phenibut isn't just that it is an extremely strong antinociceptive (pain-eliminating) drug, as verified in studies and real user experience--it also, with fasoracetam and even more so now recently following the addition of cocaine, completely disables the inflammatory signalling and potential of the body. This makes it extremely hard for serious problems to show visible, inflammation-process-based manifestations of CT scans to allow radiologists to make positive readings.

To serve as a medically-verified instance of this, my pulmonologist found me to have three serious live infections of heavy growth within my lungs through sputum tests--but my chest X-Ray before th visit showed completely "negative" (false negative), due to local tissues not responding to the infections by turning on inflammation process. He told me that in 40 years of practice he's never seen something quite like this...!!

This same neurological suppression, too is what has kept my liver turned off, unable to breakdown these drugs out of my body and out of my life.]
...

Now, coming back to the relevant matter at hand...

The osmosis theory may have been our best attempt to explain one of the symptoms that I have reported, namely the expulsion and loss of fluid. However, as investigators, we must assess whether this one explanation accounts for, and explains, all variables and symptoms presented. Osmotic flowing of fluids not only may not be accounting for the fluid accumulation/expulsion witnessed, it may also not be enough, standing alone, to explain the entire set of symptoms outlined, which include--

- several pounds of systemic weight (non-waste-matter) lost instantaneously, resulting in drastic and apparent volume reduction extremely far beyond the ranges of normal;

(1) a 30-point drop in pressure to 100 that stayed consistently lowered for at least weeks;

(2) becoming extremely cold, as if by sudden lack of vital insulation, in temperatures far above what I am normally very comfortable in;

(3) the experience of organs sliding;

(4) a drastic sudden shift of center of gravity that remained;

This just outlines the first symptoms. What has happened since then?

(5) As would be expected with opened intestinal and peritoneal tissues, within weeks I started to feel sensations of infectious stinging developing within my lower abdomen and pelvic floor. This was not only felt internally, but also perceived externally: both my family and friends, as well as I, started smelling what was like the *SMELL OF DEAD, ROTTING FISH*, coming from the flesh around my lower belly. Showering aggressively with many soaps did not resolve the issue, as 30 minutes after the shower, the flesh around the lower belly would re-saturate with that disgusting fish smell.

Eventually, the pain spread to my testicles, which, after a lifetime of hanging in one specific position, eventually felt ripping, stinging sensations during one night, where I witnessed them "dislodge" and suddenly now hang in a drastically different position, with completely different rotation, and drastically looser and lower, ever since then; it seems that the infection destroyed the connective or supporting structures that keep the testicular glands tethered to their attachments within the lower pelvis.

Because Phenibut blocks inflammation and more pronounced perception of psychologically-apparent pain, no doctor could get a positive "scan" on anything. Simple spoken facts of the extreme danger and emergency status of my case fell on deaf ears. Eventually, i was able to get one doctor to agree to prescribe me zero-order antibiotics, which, after combining them with nanosilver solution (increases the effectiveness of antibiotics by 10,000 times as per studies), both the infectious stinging and the fish smell went away after a few days.

--Purely theoretically-speaking. If the intestinal and peritoneal membrane would not have been perforated. Then it is reasonable to expect that such an infection in the very days and weeks after, would not have happened. Bacteria aren't able to cross thru the intestinal membrane en masse unless there is some serious problem. This is almost common sense.

(6) Was this enema-induced tear the only tear? No. Sadly, as a result on ongoing tissue brittleness and cocaine saturation, multiple other tears have manifested in different parts of my GI tract. The one caused by the enema I didn't have to worry as much about in terms of food and beverages, as they would be absorbed to the fullest degree possible before they reach the large intestine. However, in the case of more recent teaars in the earlier parts of the small intestine (of unknown cause or catalyst), I have, for the last six of seven months (since about May), been consuming food and ingesting beverages that, within one or two minutes, end up sitting on my pelvic floor on top of my prostate and around my organs.

This is no exaggeration. I can take a cup of ice cold water, drink it quickly--and within a minute, I feel sudden ice-cold sensation pooling up around my prostate, around the outside or reverse side of the internal anal sphincter rim, and my scrotum becomes about 10 degrees colder instantaneously.

If I eat ginger, I feel that classic ginger sting on my prostate and pelvic floor tissues about 1 - 2 minutes later. If I drink coffee that is brewed to be very acidic, I will feel the acid tingling there in the way only an acid can. If I eat crunchy, hard-shelled tacos or chips, and DON'T CHEW WELL before I swallow, I will feel the chip corners poking me all around the pelvic floor and the *reverse* side of the end of my colon.

This serves as further evidence that my peritoneal space has been infiltrated. In a sane society, a story like this would be grounds for immediate emergency treatment, exploratory surgery and eventually fixing whatever's there, with smart doctors realizing that at the root of all these complications is a systemic drug poisoning that just MAY BE possible to resolve using currently existing technology (charcoal-base hemoperfusion / M.A.R.S.) to extract the drugs back out of the body.

But everytime I go to the ER or any hospital about this, they see no inflammation, no pain. They fill me with another 100 X-Rays worth of radiation by means of another CT scan, and see no inflammation--nothing unremarkable, except for "apparent bladder wall thickening," which doesn't make sense and they can't understand why it's there. I explain to them that it's not bladder wall thickening, it's all the stuff I've been eating piling up in there. But their brains turn off, they refuse to proceed beyond anything if the CT scan is negative, and they force me to get discharged. It's like they are robots, that can't think accurately enough to perceive the reality of what is happening directly in front of them.

I have lost my faith in this system.

...

To suspect other causes in a prudent manner may be one thing, when a clinician has not yet beheld all the facts. But in my case here, doctors and ER staff have seemingly no interest in reading of hearing anything about my case. They have very regimented thinking: "No I can't read anything about this. If it's anything that we can't treat today, you just need to talk to your primary doctor about it. And, we can't do anything because the CT says negative and we have no further capacity to hear other details about this complex case." It's like they don't want to know. This puts me in the worst position one can be in.

A bit of old ancient wisdom--a proverb: "You know a thing by its effects."

We see the effects--so what is the thing?

...

Are we able to rule out peritoneal tear and infiltration by this point in time? Is it the most likely suspected explanation for what we are seeing, now that we continue to see more and more about my case?

Please forgive me for the lack of details in my earlier messages. This dialogue with you has been very valuable to me, as it allows the opportunity to practice to present my case. Like I said earlier, I KNOW what the truth is, in advance of me writing this. I have chosen to release information slowly to test where is the logical tipping is in others hearing this, who are not already acquainted with my case.

Before I close, I'll offer a story from one of the articles and reports about cocaine-induced intestinal ischemias. Generally, they are fatal about 20 percent of the time.

One particular story, the patient comes in, ER doc sees he has abdominal pain. The patient is having an immune reaction, plus there is inflammation in his belly causing distention. CT scan, however, fails to find any free intraperitoneal air, which often is the only sign. To specify, there was no inflammation or "damage" visible in any of the intestinal tissues.

Any doc with this information would have said "It's just XYZ, CT scan is negative so it's probably nothing, we're sending you home now." But this particular doctor asked additional questions to probe about the patient's drug use. The patient finally admitted that he had taken cocaine recently.

Again, any typical doctor with this information still would not have connected the dots. ("Cocaine, okay so what. Every third person coming in here practically has got drugs in their system.") But this doctor had the right hunch--he established a high-degree of "clinicial suspicion." He made the decision to engage in immediate emergency exploratory laparotomy--an admittedly bold move to cut some open because of belly pain with prior coke use, especially with a negative CT scan.

What did the doctor find? Gangrenous intestinal material all throughout.

His hunch was right: it was cocaine-induced ischemia.

...

I need a doctor of this type of caliber. Fortunately for the doctor and the patient, the patient's body was showing normal signs of inflammation and immune reaction. However, if that were me in his shoes with the exact problem--now it looks like a guy complaining of belly pain with a comparably negative CT scan (it is somewhat typical for CT scans of cocaine-induced damage to appear negative), who also had no distention, no fever. No immune markers. I can explain that other doctors of mine have found the low inflammatory markers and low immune response in the presence of serious infections, but they either cannot, or are emotionally or psychologically unwilling to, process all this information in a way that proves their initial assumptions wrong.

I'm in a difficult spot. I hope that your professional opinion can restore some confidence of mine in medicine.

Please let me know if the facts, taken together as a whole for yourself now, Doctor, are painting an entirely different (and hopefully more clearly accurate and even obvious) picture for you know.

Thank you so much.
doctor
Answered by Dr. Vivek Chail (2 days later)
Brief Answer:
There is a possibility of multifactorial cause and effect

Detailed Answer:
Hi,
Thanks for writing back with an update.

I completely agree with you when you say that you are experiencing certain symptoms at times and this can due to a combined effect of the procedure and secondary effects in your system and the environment.

Your health is a balance of your internal anatomy and the functioning of various organs, any procedure or abnormal pathogens and the environment surrounding you.

Each of the above has a part to make you feel good and live healthy.

In your case, the procedure was a triggering factor for a sort of mild chaos like situation within and as we obey the laws of physics, there was an unintentional expulsion of fluids.

The environment at the time of the procedure is important. As you know, certain chemical reactions take place at certain temperatures. We are warm blooded and the core temperature is different from the environmental temperature or the temperature of the coffee enema. I feel any drastic difference in the temperatures might have caused more of fluids to diffuse.

Peritoneal tears are not uncommon but most are small enough to heal themselves. After healing it can also cause pain due to scarring of tissues and this is not always visualised on a CT scan.

Please let me know your thoughts.

Regards,
Above answer was peer-reviewed by : Dr. Kampana
doctor
doctor
Answered by Dr. Vivek Chail (0 minute later)
Brief Answer:
There is a possibility of multifactorial cause and effect

Detailed Answer:
Hi,
Thanks for writing back with an update.

I completely agree with you when you say that you are experiencing certain symptoms at times and this can due to a combined effect of the procedure and secondary effects in your system and the environment.

Your health is a balance of your internal anatomy and the functioning of various organs, any procedure or abnormal pathogens and the environment surrounding you.

Each of the above has a part to make you feel good and live healthy.

In your case, the procedure was a triggering factor for a sort of mild chaos like situation within and as we obey the laws of physics, there was an unintentional expulsion of fluids.

The environment at the time of the procedure is important. As you know, certain chemical reactions take place at certain temperatures. We are warm blooded and the core temperature is different from the environmental temperature or the temperature of the coffee enema. I feel any drastic difference in the temperatures might have caused more of fluids to diffuse.

Peritoneal tears are not uncommon but most are small enough to heal themselves. After healing it can also cause pain due to scarring of tissues and this is not always visualised on a CT scan.

Please let me know your thoughts.

Regards,
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Hello Doctor, I am writing in regards to a specific

Hello Doctor, I am writing in regards to a specific medical scenario. I am seeking your professional medical opinion on a matter, which I shall set up as a kind of posed scenario, with details as follows... Patient (which, for all intents and purposes, may or may not be me) has had CT scans of abdomen-pelvis done both *before* and *after* a certain "event," "procedure" or action. Before sets and after sets of CT scans are provided for reference. All images in both sets have been sized and adjusted from CT scan disc images to be "very near" to same scale, covering same cross-sections, on both sets. Where shown, abdomen is same width in each set, and where length is shown, images show the same corresponding lengths along the same one patient, such that image overlaps may be compared, "flipping one to another and back," for best comparison. Each set of CT scans, when taken and reviewed by two different radiologists (the second with no knowledge of the first), was marked as showing “no significantly abnormal findings,” with the exception of some constipation and kidneys only slightly out of range of normal size, for the first scan only.

However, the exercise will be as careful observation and to compare/contrast both sets, to remark on differences, and to postulate the relevant possibilities of cause as to account for the difference in what is seen.
…

 You can obtain the images that have been uploaded directly to this file storing site, at these links:


 (1) https://ufile.io/owpmo
 (2) https://ufile.io/pcsbz
 (3) https://ufile.io/vzuaw 
(4) https://ufile.io/fzemq

 and, 

(5) https://ufile.io/ojabz
 (6) https://ufile.io/1ofhp

 …

 Please observe the first “before” set, which is the left-hand side.

…

 Then, please observe the second “after” set, side-by-side with the respective corresponding images from the first set on the left.

Note the principal outstanding feature is a clearly apparent reduction in abdominal volume. At a superficial glance, this may be single outstanding or notable difference.

 Now—for the purposes of this exercise, the nature of the “event” that transpired in-between the “before” and “after” sets will not be explicitly revealed; instead, it will be our exercise to postulate what we do see, and compare it to a hypothesis, establishing both what evidence we have to support the hypothesis, and what evidence we have that might rule it out, if any .

…

 To note: This case is not a typical case. What is being observed in one small aspect of an extremely complex, and medically unprecedented case that covers many different areas and specialties. The details of that will not be examined as of yet, for now, but we will focus only on what is being presented here.

The professional opinion here being sought will be extremely important to establishing and building a certain case, which, as already suggested, is a highly atypical one. I only ask that the radiologist examining this case be open-minded, look very carefully, and take all possibilities that are even remotely plausible as being worthy of high consideration .

…

 Select facts to accept or take as granted, with regards to this case:-- FACTS:

 (1) The patient’s weight is anywhere from “a few pounds” to “several pounds” less at the time of the second CT scan, as compared to the weight of the first.
 (2) The patient’s blood pressure, normally stable at around 120 - 130, was dropped by 20 - 30 points, to a level of about 100, after the “mystery procedure or action”; this was the blood pressure at or around the time of the second. All other factors are held constant, no change or presence of prescribed meds, no drugs or other circumstances that would alter blood pressure.


To form this as almost a kind of hypothetical test question from a medical school (although this is a very real patient and case, currently unresolved):

“After observing both sets of CT scans and noting the difference between their respective abdominal volumes, Evaluate the hypothesis that the “mystery procedure” that took place may have been a removal of peritoneal fluid from the patient, either by peritoneal drainage/lavage, or any other means of removal.” 

[Note: The two main methods of causing a reduction in a reduction in peritoneal fluid volume, may be via drainage procedure, and also by peritoneal tear.

Generally, for the first, it is generally accepted that procedures such as peritoneal drainage as only undertaken by medical establishments or doctors in cases where ascites is observed, as a means to reduce an observable excess amount of fluid build-up.

For the purposes of this question, the radiologist is asked to ignore this practical reality, instead looking to observe whether such a cause may have been carried out, either legitimately or illegitimately, to produce the effect that we do observe. 

It is also understood that in such a patient, it may not be “all” of the peritoneal fluid removed, but simply enough to restore a proper balance of volume and pressure. Disregard this conventional assumption, too, as being any basis of ruling out or weighing evidence against the likelihood of peritoneal fluid reduction. (Imagine a potential, although completely hypothetical, “basement scenario” where one “self-administers” a peritoneal fluid drain, forcibly removing virtually all peritoneal fluid.) 

Furthermore, for the second method described above—peritoneal tear—it is generally accepted that such a tear, although itself usually invisible to a CT scan, would produce trigger manifestations of inflammation and distention within the abdomen that would be picked up.

For this, too, the radiologist is here asked to ignore this presumption: instead, the radiologist is asked to take for granted and accepted that the patient here in question has chronically high levels of a combination of drugs (not limited to vasoconstrictors (a kind of which is known to cause intestinal ischemias……(big hint)), and gabapentinoids and/or voltage-gated calcium channel blockers—though not gabapentin) that prevent any significant manifestation of inflammation whatsoever in the patient that would otherwise be evident in someone from a normal population—and also understand that other doctors, in other areas of specialty, have made the observation that inflammation was lacking, producing a “false negative” on other types of X-ray imaging, where other tests and observations showed there to be very serious presence of infection and potential damage; the lack of expected inflammation was noted as both being “real” and also “highly unusual.”

 While peritoneal tears may normally present obvious inflammation, assume this patient is rendered incapable of producing inflammation that would otherwise be picked up on a CT scan.]

 Furthermore:

 “(1) Estimate the amount of both volume as well as weight that can be visually estimated, that is apparently lost in the patient between the “before” scan and the “after” scan.

 (2) Estimate either the amount or proportion of peritoneal fluid present in the patient in the “before” set.

 (3) Estimate the amount of proportion of peritoneal fluid present within the patient in the “after” set.

 (4) How do the two volumes compare? What estimation is given as to the quantity of reduction, if any?

 (5) With the understanding that the peritoneal chamber(s) are a “sealed volume” within the male mammal, does a finding of there having been “any significant reduction” of peritoneal volume or fluid that is apparent imply that peritoneal fluid may have been mechanically or physically removed, either by intention, or by any other potential or inadvertent means of escape? Consider all facts given above. 

(6) What other factors can account for any abdominal volume change? List: change in
 (a) intestinal volume (gas, matter, constipation, etc);
 (b) significant change or decrease in fat distribution, as reflected by proportional distributions of subcutaneous and visceral* fat volumes
 (c) changes in lung air volume

Furthermore, add any other factors that may be left out.

 (7) Evaluate the potentiality of each of those factors, with each of them either admitting them as likely or ruling them out as unlikely.

 (8) Establish an estimated probability chart, where out of a total of 100% of the “pie” among all of them, each of the few or several possible contributing factors are given a percentage rating as to how much to the total volume change they may be contributing. 

(9) What is the leading suspected cause or assessment? 

 (a) If it is “apparent reduction of peritoneal volume by some unknown or unreported event,” please render the final opinion that “The most probable explanation and cause for the observed change in abdominal volume, along with other facts and symptoms reported alongside, is a reduction in peritoneal volume.”

 (b) If it is any cause other than peritoneal volume, then would there be enough evidence against the “peritoneal hypothesis” to rule it out completely? Can the opinion of “No peritoneal volume change” be supported by any observation that the before and after sets both contain the same exact amount of peritoneal fluid volume, if they do?” 

(10) If peritoneal fluid volume reduction is ruled out, what does account for the totality of the volume reduction observed?

 …

 Before answering the above questions, please note the additional facts:
-- FACTS, CONTINUED FROM EARLIER:

 (3) Patient reports living in a very cold climate. He also reports that, due to being acclimated to the cold, he extremely rarely, if ever, feels any cold in sub-freezing temperatures ranging from 20 - 30 degrees fahrenheit, while wearing a thin coat. This is regardless of any change in any relevant factor, such as fat stores, intestinal content, etc. The patient also reports that, immediately after the “event” that happened, all of a sudden, anytime temperatures dropped from room temperature (72 - 77 degrees) to a range within 40 - 60 degrees, the patients has found tremendous XXXXXXX at both experience tremendous cold, involuntary and violent shivers, as well as limbs that are drastically colder than the limbs of others around him when touching his hands. At 40 degrees, even while wearing double-or-triple coats, he is still violently shivering cold, with limbs drastically colder than anyone else standing around him with only a shirt or sweater on; this may suggest lowering of core body temperature, which has never been reported as a phenomenon until immediately after the “mystery event.”

 (4) Patient notes not only himself notes and observes the reduction of volume, but also notes a drastic reduction in outward pressure from his abdomen. In his own words:

“All my life I had at least a slight pot belly, no matter how much weight I lost. There was never any kind of dip below the ribs—but more importantly, whenever I’d press against my loosened belly, there’d always be resistance, presumably by the sheer volume and weight of the internal abdominal matter. Imagine a bread bag—imagine filling up the plastic bread bag up all the way with water and tying it, and then holding it in one hand, while you poke with a finger at the bottom of any one of the sides. The sheer pressure of the volume would resist your finger, you wouldn't be able to press in far at all.

Now, since [the mystery event], it’s not just that my abdomen has lost 40% of its height when I lie down (verifiable on CT images), but when I’m standing…now when I press against the lower belly into my gut, there’s virtually no pressure, no resistance. It is such a strange feeling. I can press in, and it goes almost all the way to the inside edge of my spine—no exaggeration. It is like pressing into a loosely hanging curtain with no resistance. Imagine pouring 90 percent of the water out of that water bag and tying it back up again. It’s flimsy, you can press in with a finger and there’s no pressure anymore, you can push all the way in till you press the inside edge of the other side of the plastic bag. There’s no more resistance. That’s what my abdomen feels like now.”


 One student, who is not a licensed doctor nor had had any kind of radiological nor gastrointestinal training, offers this in support: 

“The images I see show a clear reduction in abdominal volume, ranging from 10 - 40 percent of torso height. What concerns me the most is the relative uniformity of the decrease in torso thickness. The peritoneal volume technically extends from the pelvic floor, all the way up to the top, real up to about the level of person’s throat. If there were a sudden change of intestinal volume by gas or removal of long-term constipation, we would expect some lower-belly thinness. But the thickness of the upper chest compartment is more than 10 percent thinner—closer to 20 percent(!!!). Only peritoneal volume extends to the area around the lungs. If the lungs are held the same (full of air to the XXXXXXX as per instruction which patient reports to have followed), there should be no change. if the instruction are blatantly disregarded, I can still observe by measuring my own torso thickness and the patient’s as well, that breathing in and out does not cause the chest to rise and fall in that large of a proportion relative to the torso’s thickness.

Furthermore, it seems intuitive that the drastic, sudden increase in cold comes as a result of a decrease in mammalian insulation. Normally, we think of fat as the primary insulator against the cold. However, the organs are surrounded by peritoneal fluid primarily, which also contributes a very large proportion of thermal insulation; if a sudden change occurs that causes a reduction in peritoneal volume, the sensors around the internal organs would sense that they are FREEZING COLD. Ice cold hands show that the body is trying to re-route blood to the internal organs to deliver heat to those critical organs, because or some radical change it seems to be perceiving.

Additionally, a drastic lowering in blood/“body” pressure is revealing. A smaller abdomen with unchanged pressure is one thing. But a smaller abdomen with drastically reduced local pressure too, as well as systemic pressure, is a big sign that some mass or volume, as crazy as it would normally sound, may have been removed.”

 ... Others, playing the role of devil’s advocate, note the following objections:

 - “According to some sources online, there are only 5 - 20 mL of peritoneal In the cavity of a healthy male. More than this cannot have been removed; therefore, I have no reason to believe that the patient is not in perfectly good health.” 

- “Infiltration or tearing of the peritoneum, which is called peritonitis, is extremely rare and also presents inflammation, pain, and many other symptoms and complication that would be normally outwardly visible. Because these other signs do not appear, I have no reason to believe that there has been any such change.”

 ... However, to refute these claims:

 (1) Despite “normal” subjects showing very little peritoneal fluid, in many cases, it is somewhat common to find multiple liters of peritoneal fluid being extracted from patients in hospital settings that suffer from different degrees of “ascites.” It cannot be ruled out that there are subsets of the population that carry on with personal norms of fluid that is “chronic, low-grade” levels of increase, approaching (but not fully reaching) the few liters of volume we normally associate with ascites.

Furthermore, some information seems to suggest that there are multiple sub-pockets or sub-chambers/sub-volumes that comprise the totality of the inter-organ abdominal space. Intuitively, it seems a strange conclusion to find from a study showing an ability to only draw out 10 mL of fluid from a small set of patients, when one can routinely see many liters drawn out of patients in hospitals. This leads me to believe that the methodology of the study was flawed, and that perhaps they were only accessing one small sub-compartment from which to draw. 

(2) Rarity does not rule out an issue—only circumstances and facts do. The one rendering the opinion on the lack of other symptoms was not given the information that the patient has demonstrated, as a result of chemical action, a long-term inability to manifest inflammation or swelling, as a result of certain circumstances that will not be explored here at this time .

…

 After considering all facts carefully and analyzing CT images, please complete the items above and render the final opinion, preferably in the following form: 

“I find it to be approximately ____________ % likely or sure, that the reduction in abdominal volume observed, along with the sum total of all other facts and symptoms reported, are all explained by the one sole factor of reduction in peritoneal volume, by whatever miscellaneous action to have caused the reduction—

 --with the remaining __________ % being my belief that both the reduction of abdominal volume reduction and the entire set of symptoms are completely unrelated to any change in peritoneal volume, with all symptoms being explained by the following explanations with necessarily exclude peritoneal volume reduction: (list all causes and explanations to account for the totality of what is observed, if the percentage given to here is anything other than ‘-0- percent’).”

 …

 A technically-satisfying answer may merit a debrief with further information, as well as an opportunity to work on further details and make further opinions on additional information that may be made available on this case.

 Thank you for your time and consideration.