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Septic Emboli Killed Pelvic Mesh Victim Says Harvard Doctor

Dr. John Godleski, Harvard Pathologist

Dr. John Godleski, Harvard Pathologist

It is the leading theory of the plaintiffs in this pelvic mesh case of Budke v. Ethicon– septic emboli killed Joan Budke, age 77, after her Prolift Pelvic Mesh implant became infected.

Today on the stand was Harvard pathologist, Dr. John Godleski, to confirm that diagnosis.

Before trial, an attorney for the defense, Daniel Ball, was heard  telling Judge Hass of Camden Co. Circuit Court, Camdenton, Missouri,  he did not want this jury to hear that the bacterial infection originated in the pelvis and traveled to the lung – exactly the theory the doctor would advance.

The pathologist was very thorough in his explanation, which was quite scientific. He stood at board of pink and blue-dotted masses to explain the infectious route.

THANKS TO THE MESH WARRIOR FOUNDATION FOR THE INJURED FOR CONTINUOUS SUPPORT! 

Adam Slater

Adam Slater

 

Plaintiffs’ attorney Adam Slater explained that medical records are very clear, a massive pelvic infection became an embolism that went through Joan Budke’s leg in through the blood and into her lung, resulting in nodules. It then led to necrotizing pneumonia.

The disease overwhelmed Ms. Budke who died from the infection August 5, 2009.

The defense has advanced she died from Wegner’s Granulomas, which carries a few similarities but is treated with steroids, not antibiotics.  In the beginning of this trial, defense attorney Christy Jones admitted no doctor had ever diagnosed Wegner’s, it was a coincidental infection.

See the  Mayo Clinic explanation.

 

Dr. John Godleski, Harvard Pathologist

Dr. Godleski was clearly shown to be an expert as he presented his long list of credentials. His specialty is lung pathology at the largest pathology department in the country. He oversees five other doctors whose sub-specialty is lung pathology alone.

Showing the jury a series of slides of microscopic pictures he created, the doctor explained the colors.

Pink refers to cytoplasm, the portions of the cell that has protein in it and contains the functional part of the cell where contraction takes place.  The blue part of the cell is nucleus is where the DNA lives.  The blob of blue and pink showed more blue than you would normally expect, indicative that the army of white cells had convened to fight infection from an injury.

Macrophages at work, Stonybrook Medicine

Macrophages at work, Stonybrook Medicine

There are different kinds of white cells. The Neutrophil (NEUTRO- phil) with its multiple lobes in the nucleus are present to fight acute inflammation. “It takes up the bacteria and kills those bacteria with enzymes within the cytoplasm.” The second is a lymphocyte with a small single nucleus, usually present with chronic inflammation.  These cells battle invading organisms and are responsible for immunity.  The third type of cell is the Macrophage, it typically has a large, single nucleus, and is a scavenger, what he called a “big eater.”

Science lesson over, the jury of 15 seems riveted to the explanation.

There is evidence of infection where the mesh is present, Dr. Godleski said. Also found were cultures of staphylococcus.

Six biopsies were performed on Ms. Budke’s lungs and the doctors tested the nodules, suspecting cancer. Cancer was never found. What they found was acute inflammation and many neutrophils, indicative of a raging infection, inflammation, and an advancing pneumonia to its eventual final stages.

Budke family

Budke family

Slater- “Why is this indicative of pneumonia?”

Dr. Godleski said, “Because of the number of neutrophils. Normally its five to ten percent, when you are responding to an infection its 70, 80, 90 percent and you will see more cells. That’s what you are seeing here.”

Ms. Budke was wasting away unable to eat.  By this time a fistula infection connected her vagina to her bladder. Dr. Godleski explained the course of the infection.

“In the specimens from the pelvis we saw acute inflammation, neutrophils and we found a clot. Clots are the basis of emboli and we found a clot in the lung, so we have evidence there were emboli. We have evidence from the abscess in her pelvis, she then developed a lung infection, and in those cases it was the same organism that was cultured from the pelvis.”

Slater- “Did any doctor ever think she had Wegner’s Granuloma (WG)?”

Dr. Godleski – “It does not appear in the clinical record.  There were multiple pathologists in the hospital when she was treated. I didn’t think WG was a reasonable diagnosis.  The progression is all consistent with infectious pneumonia, originating at the site of the mesh.”  

On cross examination Daniel Ball determined Dr. Godleski didn’t normally treat patients. “I’m a pathologist,” he said.

Dan Ball, Bryan Cave Law, St. Louis

Dan Ball, Bryan Cave Law, St. Louis

Ball – “So, so far in this case we’ve had a doctor who doesn’t treat patients anymore (Dr. Anne Weber) and a pathologist who doesn’t see patients,” he said rather combatively.

Ball asked, “Wenger’s can cause pneumonia can’t it?”

“Wegner’s doesn’t cause pneumonia per se. It causes a mass that can be seen on an x-ray,”  said the doctor.

Mr. Ball indicated Ms. Budke was being treated with antibiotics and still didn’t get well, indicating she should have if it was a bacterial infection.  She had a very resistant methicillin-resistant staphylococcus, the doctor explained.

Ms. Budke was never treated with steroids, the treatment for Wegner’s, Mr. Ball established.

Wegner’s also presents with acute inflammation, doesn’t it, he asked. By May doctors now in the St. Louis hospital where she had been transferred, had still not ruled out a malignancy.

Ball – “Was the same bacteria found in the pelvis ever found in the lungs?” 

Dr. – “It was not mentioned in the lungs and pelvis, except there were reports in the pelvis where it said poly-microbial organisms, that means there were so many they didn’t identify each one.”

After April there were no further cultures of any infection in the pelvis.

Ball said that was his point, no one ever reached the final diagnosis of septic emboli that originated from the pelvis? And the test for Wegner’s was never done either.

 

Cross Examination

Under cross-examination, Adam Slater established that pneumonia, rather than clearing out everything in the airway, went into an organizing process and that became permanent part of the fibrous tissue of the lung that led to respiratory failure.

Slater read off several reports from hospitals discharges, one from Mercy Hospital, “complicated respiratory infection consistent with septic emboli;” from St. Johns, “Progressive pulmonary nodule with septic emboli.”

Did that happen in Joan Budke’s case?

“Yes that was the direction it was going.”

Ball came back one more time, in a pathologist’s role, septic embolism is rarely diagnosed, he asked. That’s correct said the doctor.

 

Radiologist Dr. William Matouzzi

Next on the stand for the plaintiffs was diagnostic radiologist Dr. William Matouzzi from New Jersey. He was highly credentialed, had a neat beard and a nice suit.   His days are spent reading a broad spectrum of diagnostic medical images including CT scans, mammograms, x-rays. He read Joan Budke’s scan. A nodule in the left lung, it said. Looking at cross sections of her body under the CT scan taken in February 2009,  he pointed out to the jurors her pulmonary arteries were abnormal, on the right side there was a pulmonary embolism, “which can be life threatening.”

Dr. Matouzzi, radiologist

Dr. Matouzzi, radiologist

“Mrs. Budke presented with a mesh infection in her pelvis and had a pelvic infection abscess in the pelvis, a collection of pus.  When it goes to the lungs it has to come from somewhere, typically the veins in the lower portion of the body or in the pelvis itself.  In her case, when there is an active infection in the pelvis from the mesh, a clot breaks off, travels to the lungs and gets seeded out to the lungs. It will go into smaller vessels to seed or spread out into the lung tissue.  That’s important because it’s a mode of disseminating infection.”

Ms. Budke had multiple nodular areas in her lungs by March 2009 he said showing the CT scan. Why is this significant?

When she came in with a pelvic infection, mesh had eroded in the vagina and shortly after she had another scan it showed a blood clot had traveled to her lung from the lower body.

“It’s the highway infected material goes up through the pelvis into the lungs and spreads through arteries into the lung tissue and creates nodules of pneumonia.”

He called it, organizing bacterial pneumonia or septic emboli. Septic means infected pulmonary emboli.

Again Slater asked about the defense argument of Wegner’s Granuloma. Dr. Matuzzi said it missed three of the four signals of the disease, she had none of those things.  “She only had one of the four, you have to have two to fit into the diagnosis,” he said.

Dr. Matuzzi’s final call was “Infection to the lungs starts pneumonia and progresses over months so severe she is overwhelmed by this; she’s debilitated; she’s succumbing to progressive pneumonia and this kills her. Respiratory failure with overwhelming necrotizing pneumonia.”

Defense attorney Ball asked Dr. Matuzzi how much he charges.

He said $3,000 for a half day, but for this trip he would have to calculate in travel which he rarely does.  Ball suggested it’s the job of a pulmonologist to culture blood, work up clinical symptoms, radiology and pathology, not a radiologist.  “They do both,” he said.

Were you aware the plaintiffs’ had a theory that mesh particles in the lungs were the cause of death for months?

No, answered the radiologist.   #

17 Comments

  1. Aaron Leigh says:

    Is predatory capitalism at an all time high, or what?

    “The ultimate test of a moral society is the kind of world that it leaves to its children.”

    – Dietrich Bonhoeffer

    • David says:

      There have been many instrumental human rights struggles throughout history, as democratically progressive societies have evolved in morality, to right long-standing wrongs: the bondage of one human being to another (slavery); the exploitation of children, women and workers; discrimination by skin color, gender, race economic/social status and sexual orientation; the denial of equal voice (the right to vote and suppression of freedom of speech)…to name a few.

      To quote a partial line, by the poet John Keats, in his Ode on Melancholy, “…turning to poison while the bee-mouth sips…” is the problem – as none of these struggles will ever find finality (or the beauty of recognition) because there will always be those who seek to undermine the evolution of true human progression (truth)…root cause = “the seven deadly sins”.

      There is, I believe, the greatest of the human rights struggles – which has festered throughout the ages, but is now only truly beginning to “bubble” to the surface (because what drives the evolution, of this human progression, is at hand). It is a struggle that transcends the flesh and bones of humankind to the very fabric of humanity. This collision with human rights happens at the intersection between medical “innovation” –to “benefit the publics’ health” and “the unmet need” –to benefit the individual patient’s health (the denial of ethical treatment alternatives, without the unwanted risk subjected to the individual patients who comprise the public health). There, within the human body, the struggle rages. As every human being’s time on this earth is limited, beneficial advancements in medicine can lengthen that time while harm can decrease, prevent enjoyment and end that time.

      There is a great evil which surrounds the “innovation” of implantable medical devices. If not convinced, all one has to do is question why the medical device lobby is unwilling to come to the table and openly converse about how these device are regulated and marketed to patients? The device lobby stands with those who want reality on their own terms –terms they of course benefit from. Specific to the surgical mesh industry, across all indications, it is not about severing the greater society at large; it is about exploiting the vulnerabilities of that society (methodically, with premeditation, one patient at a time), to further own self-serving benefit (via the shared manufacturer/physician societal ambition).

      Great quote Aaron. What world does a society of people leave to its children when it targeted its future for premeditative exploitation (via the regressive training of a surgeon to the detriment of “the civilized world”)? I remember there was a Twilight Zone episode that moved around a black box…while the prior perpetrator became the victim of the next perpetrator. Perhaps the greatest justice would be if a “preceptor” of a manmade “treatment” plague –by chance alone (otherwise how else would a preceptor be caught?) happened to get caught in the web he/she helped weave to further own, self-severing gain.

      There was, I believe, Canadian surgeon (although not at the level of a “preceptor”) who would use and advocate the metal-on-metal hips until he himself got one. And, very foreseeable (via the “substantially equivalent” linage progression of the fragmentation of “the [510(k)] predicate device” evolution) also had its design defects too. The outcome was, not only did the tiger change his strips, but a tiger was humbled into a kitten. I think there was a true believer made of “the golden rule” at that point.

  2. Aaron Leigh says:

    Before we had such a large and compartmentalized societies the “punishment” for those who harmed others was to be ostracized from their core social and vocational networks, sometimes for the remainder of the offender’s natural life. The defense attorneys, including today’s star of the show, Daniel Ball, should be ostracized. The entire team should feel shamed and be shamed by the community at large. What an ignoble life to lead. How do these people just go home and eat spaghetti and watch TV with their own families while helping to destroy others’ families. Would the speak about their own mother’s (post mortem) this way? ARE THEIR OWN MOTHERS WATCHING WHAT THESE GROWN MEN ARE WORKING SO HARD TO FURTHER- the preventable harm to women of their own parents’ ages, and arguing with a Harvard-trained pathologist who SPECIALIZES in lung pathology exclusively, only, all day every day as his primary vocation? Are you kidding me? Does Mr. Ball really expect people to believe he can go toe-to-toe over whether Mrs. Budke, a previously active and healthy wife and mother, had an autoimmune disorder or end-stage pneumonia consistent with septic emboli? Good gosh.

    SHAME ON YOU Bryan Cave Law, IN St. Louis! SHAME ON YOU DANIEL BALL. WE SHOULD BANISH YOU ALL.

    Ostracize

    verb (used with object), ostracized, ostracizing.

    1.to exclude, by general consent, from society, friendship, conversation, privileges, etc.:

    His friends ostracized him after his father’s arrest.

    2. to banish (a person) from his or her native country; expatriate.

    3. (in ancient Greece) to banish (a citizen) temporarily by popular vote.

  3. Bev says:

    Well in my case infections started right after mesh was installed. Only after all the mesh was removed did the infections stop.

    One of the problems is that the vagina in not a clean environment to insert mesh through.

    Next problem is the body does not accept it as a normal situation and fights back in many ways.

    Another problem is the mesh becomes encapsulated by the body with tissue.

    Further nerves near the mesh are interrupted.

    As time marches on the mesh become brittle leading to more nerve interruption and cutting nearby tissues.

    Prior to my total mesh removal I suffered from:

    Bleeding

    Infections

    Pain

    Weakness

    Nonstop taking of antibiotics

    Pain medicine

    Constipation

    Diarria

    Painful sex

    Loss of sexual feeling

    Hormone imbalance

    After mesh total removal most of above is cured. Still no sexual feeling, but all other problems gone or atleast mostly gone.

    The above article makes a lot of sense to me.

    Bev

  4. pulmonary embolism …. another concern and fear I had when I was researching, as I wondered if mesh fragments could also entering into the vascular system…. searching in hernia mesh complications I found one case where a younger woman died of a pulmonary embolism after fighting a chronic hernia mesh infection….. if my memory serves me well she was in her thirties , I did not save that article, tried to find it later but could not find it ….. and now to read this article of what is being revealed in court it does not shock me but makes me extremely sad….. as much as I research hoping to allay my fears , instead of a sense of “I worry too much ” my fears for my mesh sisters and myself do not seem exaggerated, inflated or unreasonable…. they are entirely possible, and I need our voices to rise higher and louder …. shame on the medical world for denial and coverups until the truth is dug up in court rooms …. shame on the lack of research to protect patients , shame on the suspect limited manufacturer studies that focused on success as being able to say no recurrences while ignoring quality of life , who cares if you don’t leak if the “cure” kills you? did any manufacturers or paid preceptors ever play devils’ advocate and wonder what can go wrong and how can we undo it ? Invested leading preceptors silenced doubters with peer pressure, the doctors who did not follow like sheep ….. God bless them for standing up against mesh, I only wish their voices had been heard in their peer groups and heeded….. as much as manufacturers need to be held accountable so do doctors need to be held accountable

    • Jan Urban says:

      Nonie, I agree with you, our despair, anxiety, along with the overwhelming fear is enough to kill us. Baby steps have finally come about acknowledging some adverse effects that mesh has caused. It ‘s not enough As I prepare for my own extraction of my mesh sling. I am finding that the door is crack opened slightly with concern of the amount of issues my body has since implant. The amount of tests I have had to do for the clearance to have my mesh removal seems excessive. I also think that the gag order is wrong but think they fear social media. I am so worried and scared. Have a good day everyone.

    • Jane Akre says:

      Noni- Thank you. Pray the jurors show as much sense as you do!

    • Bev says:

      The “Cure” does not solve the problem it was intended to solve.

      When I went to Dr I leaked a very tiny bit a few time a month. When he got done I leaked all the time needed heavy duty protection until Dr Raz fully removed. Then leaking went back to a more normal state, liveable, the mesh was not live able.

      • Jan Urban says:

        I had to cancel my mesh removal surgery. I am so upset. My stress test set off alarms whistles and sirens. I knew all the inactivity would do this. Three years ago my stress test and heart cathe was good, only a small section 15% showed up. I was a physically active women before mesh. My work entailed using every muscle in my body. I never had to exercise. 3 years later, 60 pounds, stressed out , severe pain, sleep deprived, smoking along with an assortment of other chronic ailments since my mesh implant. It certainly has become Hell. A while back I told Jack to dig the hole……When your body is injured by this mesh at least in my case it has caused a domino effect. Has anyone else developed heart problems?

        • Bev says:

          Try Dr Raz. I could hardly walk, have heart problems, and no stress test was performed by Dr Raz before surgury. He removed all my mesh.

          Heart problems were pre-existing.

          Bev

  5. linda says:

    I read MND regularly as Jane continues her excellent reporting.

    Thank you everyone for your superb comments.

    I hope everyone reading this today will share with other mesh injured women that we should all do our best

    to support Jane.I don’t think people realize this has become a full time job for her and she

    really needs our financial support to keep traveling and reporting for us. So, please pass it on….lets all try and

    send whatever we can. What would we do without MND???

    Jan, I am 67 years old and have been home bound and bedridden much of the time since my 2011 implant of the Ethicon Prolift +M mesh kit for pelvic organ prolapse ….

    … I was in excellent health before” mesh”!!!!! I was very active, both physically and mentally. This is my fifth year and I too am worried about what other problems I will encounter due to the lack of activity and also the possible side effects of pain medications for “severe” chronic pain. Even after all this time, and even with the pain meds I am always unconfortable and . I worry constantly about the arms of the mesh which are constantly tugging and pulling in my inner thighs and causing sever spasms……when the mesh moves,shrinks ,erodes and migrates… we all have enough common sense to know that there could be further complications.

    I have had two surgeries to remove the mesh kit…but neither surgeon could get all of it…. I have bits and pieces of mesh remaining and the arms of course….I have seen countless surgeons,but due to the complications involved in removing the Prolift kit in particular, I cannot find a surgeon who will take my case. Dr. Raz said he would do exploratory surgery,but did not think he could remove the arms.

    Two partial removals has taken its toll on me. And, of course, it has caused so much sadness for my family as I am

    no longer the healthy happy Mother and wife they enjoyed.

    The stress of all this leaves me feeling anxious,depressed and exhausted. My Doctor said my immune system is weakend

    from all of this …I got a bronchial infection in December and it took a month to get over it…I was close to having pneumonia.

    Reading about Mrs. Budke’s lung infection has really scared me!!!

    I do have my blood work checked regularly and after reading about your situation, I think it would be

    wise to schedule a stress test or get an EKG…..stress is a killer and certainly can cause heart attacks.

    Of course you are disappointed in having to cancel your surgery…thank God you did not suffer a major

    heart or neurological event. Thank you for sharing.

    How tragic that we have to live like this.

    linda

    • Jan Urban says:

      Thank you Linda. Do not rely only on a EKG and Blood work. I had other heart tests along with the stress test. Ultra sound neck and belly, nuclear imaging. Guaranteed a heart cathe is next. Heart Cathe is easy they go through the wrist instead of the groin. Had one 3 years ago and I was fine. So get to a Cardiologist.. Your mesh implant is one of the worst and almost always impossible to remove. I will be thinking of you.

      • Jan Armour says:

        Jan, I have the J & J tvt Gynecare for SUI. I am hoping it is not as difficult to remove as I am waiting on an appointment with Dr. Veronikis in ST Louis. I have had it for 10 years, that bothers me a lot. I guess I will know more after he gets time to look over all my medical records. I just pray he will be able to do a total removal.

  6. Hope Pagano says:

    Should I be concerned about the UN-identifiable bacteria that has been detected in my urine for over a year? Antibiotics have not been able to cure it.

    That poor woman the suffering she must have endured, not to mention all the doctors appointments she must have gone to only to be misdiagnosed or dismissed. Horrible.

    Thanks for keeping us informed Jane. You are God sent!

    • Bev says:

      The infections will only stop once all of the mesh is removed. Make sure that it is all of the mesh. Partial removal is worse than no removal.

      See Dr Raz.

  7. Disgusted says:

    Yes. This is dangerous as you can see from what Ms. Budke suffered it can go septic. I do not understand why it hasn’t been sent out to another lab if they can’t figure it out. Also be aware that yeast can also infect the bladder and won’t show for bacteria. I hope the infection isn’t causing unbearable symptoms. Hang in there.

  8. Mary pat says:

    I thought nerve damage and nerve pain was as bad as it gets. Now we are learning that infection kills. I wonder how many mesh victims have infections that go undiagnosed. Bone infections are difficult to detect and nearly impossible to treat. This is bad. Very, very bad.

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