Herman Boerhaave (1668-1738) is known today by physicians as the individual associated with Boerhaave's Syndrome. Arguably a process that seems beneath the dignity of such an important physician - a tear in the lower esophageal mucosa secondary to emesis (vomiting) which is usually due to over-drinking.
Herman Boerhaave was a botanist, in addition to being a physician (and other positions). He is recognized as a pioneer in medical teaching, modern hospital ward design, quantifying items, and critical to this blog, associating symptoms with disease.
I have to think on Herman Boerhaave, when I think that there at least 5,000 individuals who are on-line, who believe they have Gadolinium Deposition Disease, and I believe many of them likely do have it. Yet where is the interest and enthusiasm in physicians and scientists to study this group. They are not only interesting as the disease itself: with all the aspects of metal toxicity, multicellular host immunity, neuropathy, the substitution of cations in in vivo biochemical reactions, and genetics, but also the broader implications for all heavy metal toxicities as well. This is a situation where the quantity of heavy metals delivered can be determined, unlike lead that may be coming from water pipes or mercury coming from contaminated fish.
Prior to Boerhaave, for more than a millennium, European 'physicians' studied old Greek texts (sometimes), folklore, and focused on the 4 humors: blood, black bile, yellow bile, and phlegm; the superstitious concept introduced by Hippocrates but refined by Galen. Patients were never really examined: to determine symptoms, causes, response to treatment, just physicians looking at the superstitious old books. So I do find it somehow dark humor that many physicians, especially radiologists, weigh in on the idea that GDD does not exist, but not by any direct patient contact (almost all have none, and deliberately avoid it), but by reading the old texts on NSF, and since these GDD individuals have normal kidney function, they can't be sick from gadolinium. I find it quite remarkable really: do they think it is yellow bile or phlegm that is the cause?
I am also reminded of the Seinfeld stand-up comedy routine where he talks about doctors, and just to select one segment of a great routine: he describes the physician going into the back room, after seeing the patient, he frantically pages through his text-book, and says something to the effect 'what the hell was that, it wasn't the circle or the tube'.
Harken back to Boerhaave physicians and scientists, and help figure out this disease and its treatment. If you are worried about preserving the use of GBCAs, the best way to do it is to identify patients at risk, treat them early and successfully. This is my focus.
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