GREEK MYTHOLOGY and A MODERN DAY RENAISSANCE MAN – Dr. Dionysios Veronikis
An open-source article bylined by The Mesh Warrior and contributed to by his Patients
November 24, 2014
Dr. Dionysios Veronikis
FELLOWSHIP: Vaginal Surgery & Urogynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
RESIDENCY: Obstetrics & Gynecology Baystate Medical Center, Springfield, MA
INTERNSHIP: General Surgery, Morristown Memorial Hospital, Morristown, NJ
MEDICAL SCHOOL: University of Patras Medical School, Patras, Greece
Diplomate of the American Board of Obstetrics & Gynecology
Diplomate of the American Board of Female Pelvic Medicine & Reconstructive Surgery
Fellow of the American College of Surgeons; Chief of Gynecology – St. John’s Mercy Hospital – St. Louis, MO
Director of Reconstructive Pelvic Surgery & Urogynecology – Mercy Hospital – St. Louis Obstetrics/Gynecology
Residency Program Director – Mercy Hospital – St. Louis Society of Gynecologic Surgeons Active Member
LANGUAGES: • English • Greek
OUT-OF-THE-CLEAR-BLUE SKY, BUT A MOST WELCOME EMAIL
My first voice-to-voice interview with Dr. Veronikis was in August (2014). I had written him in December of 2013 requesting an interview, but he was not able to respond to my questions (understandable, of course, with his busy schedule). A very friendly and brief email discussion ensued. I shared a bit of my mother’s journey with mesh; that I am a patient advocate and writer and a hearty “Merry Christmas.” I also shared an email with him, containing each question I’d be asking so he could easily prepare on his timeline. He was very friendly and amicable, responding:
“I would be happy to answer your questions. It may take me a few days. I am glad to restore the quality of life for women.”
Unfortunately, I did not from him again for many months, and thought he wouldn’t be able to make the time, but then very much to my surprise, and somewhat out-of-the-blue, he contacted me by email, August 7, 2014 – a full eight months after our initial email exchange.
His email read:
I am not sure I ever responded to your email. It fell off my radar.
I still help women and that is my focus.
I have put together a website to educate women on mesh removal. It is under construction.
It shows the breadth and depth of mesh removal.”
And my emailed response:
“Thank you Dr. Veronikis. This is helpful. Perhaps a brief phone interview would help as well. Let me know open times in your schedule, and I’ll work around your availability. Thank you for helping the women.
So on that footing, and from that context, we set a Sunday morning time to speak and began a conversation in earnest in August, the kind I enjoy immensely: real people speaking to one another about a REAL BIG problem, which must be solved by many different kinds of people working in collaboration: doctors, nurses, scientists, patients, patient advocates, hospital administrators, family members, communications experts, writers and journalists, even lawyers, insurance companies, and yes manufacturers, not to mention the FDA and other “safety net” government entities like Medicare and Medicaid. That’s how big this problem is. Using the analogy of a train wreck, which I often do, we in the community of injured patients and family members call the wreckage “MESH HELL.”
The list of people needed to aid the injured is literally endless, as train cars still crash into the back of this devastatingly-long and brutal scene of immensely profound and often irreversible harm and injury continues daily.
The mesh is still on the market; still being used; still being implanted; still maiming.
OUR PHONE CONVERSATION BEGINS
“How much time do you have?”
“How much time do you want? I’ve allocated an hour.”
In both the writer’s mind and as one who’s starting a non-profit, I consider this a green light to ask every single question I can possibly think of, and I’m already excited that Dr. Veronikis has called right on time and seems to be focused in a quiet room somewhere. Maybe he’s flexible I think, as in: ”Let’s have a conversation, flexible,” not a formal, stoic interview kind of exchange.
Cool. That’s my style. I think doctors and patients should have more good, old-fashioned conversations and less 15-minute “consultations.”
I start out with the usual questions – background, education, personal history. We talk about my name and how he thought it was funny that in some of my bios, I have written about my name, making sure to advise people ahead of phone and email conversations that I’m not, in fact, “an elderly Hebrew or Jewish man (though I certainly do like most elderly Hebrew and Jewish men I’ve met).” I clarify that because I don’t want new colleagues to be confused when a 30-something woman who claims to be a writer on the internet, this “Aaron,” answers the phone with an obvious higher pitched female voice.
If you can “rib” someone during a conference call; I certainly did, answering Dr. V’s conversational serve with a volley, “You wouldn’t happen to be Greek would you, ‘Dionysios Veronikis?’” He chuckled acknowledging he’s always liked his name, and that “it’s a good name to have in his culture.” In Greek and Roman mythology, Dionysios means, “the god of wine, fertility and drama.” We laugh again because, after all, we’re having a conversation. We run through his credentials and schooling quickly, and there is no doubt, his accomplishments are prestigious and many. The man is well qualified and he knows it. . . as he should.
After attending medical school at the University of Patras in Greece and completing his residency at Baystate Medical Center, he began his 20-year career in his current, chosen specialty with a three-year fellowship in Vaginal Surgery at Massachusetts General in Boston. He is now Chief of Gynecology and Program Director for the OB/GYN Residency Program at Mercy Hospital, St. Louis. Certainly, these are no small accomplishments.
In this current version of our healthcare system, doctors are expected to be, not only exceptional doctors or surgeons, but also businessmen, marketers, managers of cross-departmental teams, philanthropists, leaders in their communities and many other roles you can probably imagine. “Dr. V” as he likes to be called is a busy man to say the least. These additional roles are sometimes referred to by industry as “down pressures.” This, not coming from Dr. V. but from my learnings and speaking with other physicians.
Where we land jointly at the end of our opening volley is a quotable moment. Dr. Veronikis offers this:
“What you take away from all your education is common sense,” he says.
These two words (common sense), music to my ears, as I reflect on the story I wrote more than a year and a half ago now about my family’s journey to help my mom find out what had gone so terribly wrong with her mesh implant surgery. I assumed the good doctor read my bio as he’s cited my writing once already, and I wonder if he read my family’s story as well before our scheduled conversation. He seems prepared for our talk, and that is admirable and honorable to me, a quality we should all aspire to posses.
I remember, very specifically, struggling to find the right phrase when writing the portion of my family’s story related to what it was that so many of my mother’s treating physicians seemed to be lacking. I couldn’t quite put my finger on it as I stared at the pages I’d written, but then the thought occurred to me, “This is all common sense,” and so I wrote it that fateful day last July (2013):
AN EXERPT FROM MY STORY:
“How is it that I am the only one asking these questions?” I’m no doctor or specialist, but this is logic, project management, common sense. Why aren’t any of these doctors interested in the cause of such an enigmatic syndrome? Why don’t they have a hunger to know more, or at the very least, a compassion that would drive them back to the curiosity of their med school years?”
The question persists more than a year later, for both Dr. V and me. “Where has common sense gone?” we both wonder, for him in the misuse of mesh products and its commensurate procedures; for me in this entire living, breathing medical organism that is our (often deadly) “health” coupled with ”care” system.
Dr. Veronikis adds:
“Some of these mesh procedures [as previously performed by other surgeons in many of his patients] make no sense. Some of this was experimentation, maybe, but I’ve always approached every surgery I do as an obligation,” (again music to my ears). If you, as a surgeon, aren’t very confident that you can take care of any complications that arise, you don’t do the surgery. I also take on complications that other surgeons won’t take on. Sometimes I will do surgeries, and I don’t know the outcome of it, so I tell them [my patients] that they are partners in the surgery – I am doing if for them, with them.”
It’s nice to hear a doctor, in his own words, speak of working together with patients and their families to make the best decision based on the medical truths he can offer them. He concedes but not with conceit, “I have a skill set, a gift, blessings, etc.”
Personally and professionally, I am so grateful that Dr. Veronikis has chosen to take this horrible, highly injurious product OUT of women, for I believe mesh removal is the first step towards recovering the bits and pieces of one’s former quality of life or growing anew towards another, different life – but with hope for a better quality of life, one WITHOUT MESH.
I interrupt and say, “I completely agree with you and understand you are a gifted surgeon and this surgery is very difficult, but let’s see if we can take off our respective hats; me in my writer’s hat and you in your doctor’s hat. Let’s you and me just talk – human as to human.” He agrees, and then I say, “I’m not a journalist. I’m really more of a writer.” He says, “What’s the difference?”
I like this question.
It shows so many of his cards at once, and I now know; (At least I hope I’ve read his curiosity correctly.) this is a humble man’s correct assertion that none of us knows it all, so we should ask questions when we don’t know the answer. After many visits behind the closed doors of exam rooms with my mother, and “consultations;” with doctors; some bordering on and possibly right over the line into psychological and mental abuse of my mother as a patient, I’m grateful on my mother’s behalf to hear Dr. V’s words, and I take it to mean Dr. Veronikis and I respect one another. Mutual respect is part of the “common sense” part that was lacking in much of the doctor-t0-patient behavior I saw behind those closed exam room doors with my mother’s treating physicians:
I hope our even hand is revealed in equal parts in all suits.
SPADES in what I hope I perceive correctly as humility to admit we don’t know everything there is to know.
The suit of HEARTS, reflecting a desire to find answers to questions in this pursuit to render aid to the injured.
And like compressed carbon, the suit of DIAMONDS; the ability to be diamond-grade professionals, lumps of coal, refined under tremendous amounts of pressure the result of which is what I hope helps turn something terribly ugly into something of rare triumph. And all at the same time, just being fellows in humanity, trying to figure out the MESH MESS, each with our God-given skill sets and blessings.
And of course, let’s not forget the suit of CLUBS/CLOVERS, for the good fortune to find answers by working in tandem to solve a multi-faceted problem; to discuss a very serious threat to the health of harmed patients and to the overall public’s health and safety. Maybe, working together, we can emerge from this MESH MESS with some tiny solution, a small victory that furthers all of us towards a better cure for those injured and safer treatments for the restoration of female pelvic health for future patients.
NO ONE PERSON (OR DOCTOR) IS ALL GOOD OR ALL BAD.
EVERY PERSON IS A MIXTURE OF PARADOX
I believe doctors do their best, in most cases, of due diligence when a medical device rep walks into the office with “the latest and greatest” drug or device and lunch for the entire (often underpaid) medical staff and office staff members. I believe most doctors do take this aspect of the medical profession with the commensurate grain of salt, and they absolutely think through the safety of what is being proposed to them by manufacturers, who bring an obvious motive, above and beyond patient health and safety – to increase sales. After all, they are are said to be in “medical device SALES.” Consequently, I do my best not to vilify doctors; though, I do know many by name who are culpable for using their status and scalpels, at best, irresponsibly and, at worst, knowingly and unscrupulously for personal financial gain by performing unnecessary procedures or procedures for which a reasonable doctor would require additional training to safely perform.
But as any broad group of people, we cannot judge all to be the same. There is as broad a spectrum of competency amongst doctors, just as there is amongst mechanics or plumbers. The notion that “all doctors have the same level of skill or qualification” is the part of the common sense that we, as patients, have inadvertently abandoned, albeit, under illness and duress; cultural norms and pressures; and perhaps a lack of knowledge (for we are NOT doctors, nor should we have to be in order to give true and proper informed consent.) Not all mechanics are the same; not all doctors are the same. Some are more passionate about their professions and long to improve procedures and outcomes or invent better solutions; or even make medical history while others just want to make it home for dinner. The reality comes across the page as harsh, but it’s reality whether you choose to believe the reality does nothing to change it.
I believe Dr. Veronikis is in the latter group, a dedicated and curious surgeon, a true physician who desires and delights in his ability to be an instrument of healing for others.
I don’t make medical recommendations because I’m not a doctor, just as I can’t tell you what to do about that weird sound your car is making every time you turn right or why your sink backs up every time you wash clothes. I did not go to medical school or complete a mechanic’s or plumber’s apprenticeship. And I certainly did not complete one or more fellowships after medical school or (sheesh) use a scalpel on a passed-out person. And well Dr. V- he’s not a professional writer or marketer, or a COO, CMO and CEO. He has not been trained in the creative and production processes employed by writers and leaders of business groups.
Cool, again. We’ve already learned much from one another. I feel like we’re SOLVING, not DEVOLVING. We can approach the problem from different angles, and each bring solutions. That’s EVOLVED thinking.
I share with him that I don’t vilify doctors in this Mesh Nightmare and why. In addition to the above, I see any doctor with a heart to help, with regard to mesh explant and the whole attending tangled ball of yarn, as in the same situation as the rest of us. We are all bewildered, to an extent. How do we handle this toothpaste now out of its tube, so to speak. Developments in the courtroom, exam room, conference room, operating room, and even in the online chat rooms take many of us by surprise daily. Regardless of how this unprecedented and most twisted ball of yarn got into our collective hands; here we all are, holding some portion of string, or a knot. We’re covered in toothpaste; stuck holding the bag; whichever analogy you wish to use. We are ALL OF US, wondering:
“What happened? What is HAPPENING? What do we do to help ourselves? How do we help all these very ill and badly-injured people? We all must stop and render aid to our families and others using our various skill sets, blessings, etc. immediately. How can we best give assistance? And however we choose; it’s got to be STAT!”
Dr. V and I are looking at this problem together, on a Sunday morning, in its sum-total, as we each understand it, from different angles. A Rubic’s Cube is the image I’m holding in my mind. Where to start untangling the yarn, what end to cut first, quite literally for him? I believe the most true answer to this question is:
No one knows exactly what to do, including manufacturers and doctors, even very, very skilled surgeons; because no one has performed polypropylene mesh explants en masse after 5, 10, 12, 15 or more years of the intruding foreign body’s multi-year layover in a human patient’s body.
And every human is different.
Some have rare co-morbidities, clearly incompatible with mesh implant.
Some have pre-existing autoimmune issues.
Some develop inexplicable and rare symptoms and autoimmune disorders that were never present before mesh implant.
Human beings are not one-size-fits-all.
The mesh does not have the exact same effect on every human body, although there are certainly many patterns, significant similarities and common symptoms among most every injured person I’ve encountered.
How do I know that what I just said is true? For one, it’s my personal experience, now as a result of more than three years of be immersed in this community of injured patients.
More importantly: the manufacturers and FDA themselves told me. They told us all – BUT- mostly after the fact.
NO ONE, AND I MEAN NO ONE ON THIS PLANET, has ever done TIER ONE ETHICS, double blind, long-term, published and medically-accepted studies on LIVE HUMAN BEINGS, and there is certainly no follow-up study to measure outcomes and the effectiveness of these mesh devices . . . until now that is.
In this writer’s humble opinion, the general population was the tested upon (YOU, the patient!), which allowed for the foregoing of that pesky “Tier One Ethics” part of the R&D process for manufacturers, which is a costly and time consuming cost of doing businesses for manufacturers (as it should be). I believe PRE-MARKET, TIER ONE ETHICS STUDY OF ANY DEVICE OR DRUG is imperative and ethically necessary to safely develop OR REVISE a medical product, procedure or drug. Again, employing common sense here: If adequate studies are not/have not been done, how can a curious and dedicated doctor, such as Dr. V, even HOPE to give true informed consent to his patients (through no fault of his own)? How could he be what’s legally referred to as a true “learned intermediary,” the conduit filling the gap between the manufacturers and the real-life use of their products on the end users, who are the patients themselves? Without this medical and scientific analysis being done on the front end, before a product goes to market, how can ANY PERSON whether doctor, patient, nurse, nurse practitioner, patient advocate, husband, daughter or caregiver study and judge the safety of any medical device? And, again, through no fault of their own? The question remains: HOW COULD WE ALL BE FULLY INFORMED WITHOUT INFORMATION?
There are many hundreds of thousands, if not millions, of patients by now – worldwide – with polypropylene transvaginal and/or abdominally-inserted pelvic mesh and hernia mesh implants, a good sample size for a study done as an AFTER MARKET study, I’d say. Wouldn’t you? That bothersome problem of getting a patient’s true, ethical and proper “informed consent,” easily bypassed by the FDA’s deeply flawed policy, called the 510k Clearance process (also known as PMA/Pre Market Approval). 510k Clearance is a completely different process than the process of FDA Approval. Despite all claims of being a civilized, first-world country, medicine in the U.S. – at least from the patient’s point of view – becomes more and more like a drug cartel every year, and the more you know, the more you realize this nicely-dressed cartel is somehow legal in large part. To be certain, there are laws that manufacturers did break, which is why we are seeing the judgements against them coming out of courtrooms across America.However, let me be clear: there is no “War on Drugs,” against this cartel.
The best studies we have regarding long-term outcomes of polypropylene mesh implant, are from study done on cadavers and dogs (all euthanized by the 7-year mark), and dead people and dogs just don’t give very good advice on long-term outcomes, efficacy rates and how this device behaves (or misbehaves) in living, breathing, mothering, fathering, working, swimming, dancing, crying, suffering human beings. No one has ever done serious science on informed human beings, but the FDA and doctors alike are now taking note of the serious side effects, that, in my opinion should have been paid for and discovered by the manufacturers well before such devices were placed upon the free market to unsuspecting patients who TRUSTED their doctors.
Here is where I believe culpability of the doctor enters into the train wreck.
• Was your implant surgeon the kind of person who just wanted to get home for dinner or increase sales without a thorough review of the “science” given him by the polypro manufacturers’ sales reps?
• Or was your surgeon more like Dr. V. – extremely invested in the gynecological health of women, as evidenced by word and deed?
• How can we, as patients, tell the difference in a 15 minute “consultation,” time limits often set on doctors by their hospital administration. Time is related to profit.
Until now, why should we have had cause not to trust our doctors and hospitals, either way? After all, we’ve been told they know so much more than we; that we cannot know enough to make a judgement for our best care. “We must listen to our doctor’s advice and follow it diligently.” That is what we have been taught for generations by our culture, by our doctors themselves, by our insurance companies, by the manufacturers who tell us every night, “Take your health into your hands, and talk to your doctor about XYZ product today!” as if it’s a new kitchen appliance they are selling to us, rather than a life-altering, sometimes very, very dangerous drug or device.
So, guess what?
We did trust.
We did listen to our doctors.
We did listen to our FDA.
We did listen to the device manufacturers who advertised to us with glossy brochures and on 5:00 p.m. news commercials every night.
And now in hindsight, TRUST seems like a dirty word.
Still, Dr. Veronikis is highly-skilled and one of VERY FEW surgeons who can or will attempt to remove a device which has given way to one of the most complicated surgeries in history – polypropylene mesh explant. Without his talents; without his life story; without his CHOICE to use his skills and talents in this controversial way, where would many of us be? Much, much worse off.
WITHOUT MUCH HOPE AT ALL, that’s where.
Dr. V. agrees. Still here we are, he and I on the phone, recalling as we speak, the many missed opportunities in the “safety net,” and how VAST is this problem.
I believe the problem absolutely includes willfully malfeasant manufacturers; those of former worldwide iconic status – the great American company, “the family company,” some started by physicians themselves, scientists, or entrepreneurs whose very name and legacy was intended to by synonymous with wholesome, family goodness and good health for all. But quite clearly something has taken over, someone or something else – sales and marketing perhaps? Greed perhaps? The pressure to fulfill Wall Street’s expectations maybe? An unholy alliance between manufacturers and politicians? It wouldn’t be the first time. A combination of all and more, yet to be discovered, is most likely.
AN ODD TWIST TOWARDS THE MORE PERSONAL
I ask Dr. V. if he knows what much of the mesh-injured community thinks about him, assumes about him. He’s quick to answer, a hint of escalation in his tone:
“What have you heard about me?”
His tone all of a sudden sounds like a demand, as if to a subordinate, instead of another professional.
I’m a bit taken aback as his tone hints at a possible personality conflict or a material disagreement. Having spoken at length with both Dr. Raz of UCLA and Dr. Hibner of St. Joseph’s Dignity Health Medical Center in Phoenix, I’ve not experienced this potential for hot headedness amongst the handful of doctors or practices who will even attempt to remove polypropylene mesh. I asked all of these doctors the same questions. In fact, I had thought first about doing one story, set up as a grid, with each column having one question and each row having each doctor’s name and answer. As it turns out, the answers and the doctors themselves are not that one dimensional, and it was quite naive of me to ever think otherwise.
As if surprised himself, he begins immediately to justify his tone with his professional experience, more data points, in line with what I would think a good doctor or scientist would do, albeit out of context in our conversation, in which, we both recognize he is a leader in his profession and well qualified.
“When and how did you first learn about mesh?” And what was your initial reaction? How did you think through the new procedure and device?”
“Look, I came here on a boat across the Atlantic in 1962 with one pair of shoes. I’ve been doing surgery since 1982.”
I’m sensing frustration in his voice, as in: “Why do I need justify myself to you?”
I’m thinking, “He doesn’t need to justify himself to me, so why is he? It’s a simple and relevant question for which my readers will want an answer.”
I sense it’s not the first time he’s felt this way – a perception of confrontation by questions asked of him regarding the controversial use of mesh products.
He continued, “I went back to Greece for medical school, and I lived in an apartment complex there, and as I studied, a man in the apartment across from me read in his kitchen every night, and through our windows, we had discussions . . . every night. I learned so much from him, a general surgeon named Andrew. I asked Andrew once, ‘Can you give me the secret to doing surgery?’ His response was immediate:
‘Respect the tissue,’” Andrew had said.
Dr. Veronikis’ tone is changing to a sense of nostalgic fondness now.
“Years later Andrew came to visit me in the U.S. as he himself became a colorectal surgeon. In my three-year fellowship in Vaginal Surgery alongside David H. Nichols [who literally wrote the book on Vaginal Surgery], I really started to do a lot of reconstructive procedures.”
Dr. Veronikis continues with a levity, perhaps an appreciation of female anatomy in a medical sense and totally appropriate – not a hint in his tone of anything but a deep knowing and respect for the anatomically-correct form of the female anatomy in which he specializes:
“A woman is perfect, and when she has a baby, that breaks; and we can never really restore it to as well as its original creator.” – Dr. Veronikis
I appreciate his deference to Our Creator, but I also find myself lost in thought about the part he said about how a woman’s body “breaks” and what specifically he means by that.
A woman’s body has not changed since his work with Dr. Nichols, but the way our physicians treat SUI and POP has changed drastically in the last 20 years. That much is clear from a review of the medical literature or a review of the sales of polypropylene mesh implants.
I cannot linger in wonder too long, for as quickly as he switched from agitation to nostalgia, Dr. Veronikis is back to a methodical cadence: a list of others he’s worked with: “Dr. Nichols became Chair at Brown; Isaac Shiff was at Mass General and retired at 65; at Harvard, a Dr. Kathy, Colonel George McClure.” I am unfamiliar with these names, but I type rapidly as he speaks, and I’m grateful to be able to type so fast, because he’s rattling ’em off to be sure.
We end PART I of the interview here, and Dr. V ends his list with,
“Dr. Nichols taught me how to do slings.”
PART II AND THE WRAP-UP TO MY INTERVIEW OVER A PERIOD OF 8 MONTHS WILL BE POSTED TOMORROW. IN IT, YOU WILL READ COMMENTS BY HIS PATIENTS ABOUT THEIR EXPERIENCES IN HIS OFFICE.
PART II IS “OPEN SOURCE.” I’M ALLOWING ANYONE TO COMMENT INSIDE THE ARTICLE, BEFORE IT’S PUBLISHED, USING THEIR NAMES, PSEUDONYMS OR REMAINING ANONYMOUS.
THINK OF IT AS A WIKIPEDIA ENTRY FOR DR. VERONIKIS.
I AM TAKING COMMENTS UNTIL 5 PM CST TODAY,
SHOULD YOU LIKE TO ADD YOUR VOICE.