The Sinusitis Article On Our Homepage, And More
- For Everyone,
This post has a reprint of that article on sinusitis that's been on this rosacea-cure group's Homepage since 2003. As I've explained, innumerable diseases that have no relationship with rosacea are now curable with (DMSO + fluconazole). Sinusitis is now curable with (DMSO + fluconazole), and I believe sinusitis is closely associated with rosacea, if only because the "butterfly-shaped pattern" that rosacea normally occupies on the face is identical to the placement-pattern of our nasal and facial sinus-cavities, (which are also adjacent to ocular-rosacea), AS AT:
CONTENTS OF THIS POST:
 ORIGINAL NEW YORK TIMES ARTICLE ON SEPT. 1999 MAYO CLINIC SINUSITIS STUDY
 (PRINCETON.EDU) CONDENSED ARTICLE ABOUT THAT MAYO CLINIC SINUSITIS STUDY
 THAT STUDY CONFIRMS THAT 95% OF SINUSITIS IS CAUSED BY FUNGAL ORGANISMS, WHICH MEANS THAT SINUSITIS CAN BE CURED WITHOUT SURGERY
 SURGERY IS THE CURRENT "TREATMENT" FOR SINUSITIS, AND SURGEON'S RHINOPLASTY-SURGERY DISCLAIMER IS DECEPTIVE
Doctors Rethinking Treatments for Sick Sinuses
By GABRIELLE GLASER
[DATE OF STUDY WAS IN September 1999]
Published: December 17, 2002
Over the last 10 years, many doctors have become convinced that the answer to chronic sinusitis, which afflicts millions and costs the United States an estimated $6 billion a year, could be successfully treated with surgery.
The introduction of fiber optic surgery, involving tiny scopes with cameras attached to a monitor, has become common, giving doctors access to the cramped, convoluted sinus passageways. Before the new technique was developed, doctors cut through the roof of the mouth or made incisions in the eyebrows to clear away scarred tissue or polyps.
Many physicians said they thought the new tools could help cure the disease. But now, as many of those who have had the procedure return to their doctors' offices sick once again, the early hopes for surgery have been dashed. Researchers are shifting their focus to inflammation and the immune system.
"The medical community thought endoscopic surgery was the be-all and end-all", said Dr. Michael S. Benninger, chairman of the otolaryngology department at Henry Ford Hospital in Detroit. "Surgery still has a role for some problems. But it's certainly not the solution for everyone."
Dr. John H. Krouse, a professor and the director of rhinology and otolaryngic allergy at the Wayne State University School of Medicine in Detroit, agreed. For years, Dr. Krouse said, ear, nose, and throat surgeons were puzzled when patients returned to their offices just months or weeks after having surgery. Some patients had six operations, Dr. Krouse said. Physicians, he added, began asking, "What are we doing?" and "What exactly are we treating?"
The disillusionment with surgery occurs as recognition is increasing that other common remedies for chronic sinus disease like antibiotics, steroids, antihistamines and decongestants also are falling short of expectations.
Researchers say they are beginning to suspect that they have to rethink the underlying causes. Instead of allergies and infections, long considered the primary culprits, doctors are asking why sinuses become sick in the first place. Increasingly, they are looking at inflammation or the responses of the immune system.
At this point, researchers are struggling even to define sinusitis, which affects an estimated 37 million Americans, or 13 percent of the population. The symptoms include repeated infections, persistent congestion, headaches, facial pain and malaise that can last for years.
According to the Centers for Disease Control and Prevention, chronic sinusitis is the most common long-term illness in the United States, affecting more Americans than asthma, arthritis and congestive heart disease. It strikes women more than men and is most common in the Southeast.
Sinusitis is also expensive and time consuming. It is responsible for nearly 14 million visits a year to doctors' offices, according to the National Institute for Allergy and Infectious Diseases.
The sinuses, hollow spaces surrounding the nose like grape clusters, are something of a mystery. Anthropologists theorize that they originated from evolution, allowing the head to be held upright. They also warm, cool and humidify air entering the lungs, equalize barometric pressure and provide resonance for the voice.
Each sinus has a duct no bigger than the lead of a pencil for the free exchange of air and mucus and is joined with the nasal passages by a continuous mucous membrane that, when healthy, resembles the lining of the inside of the mouth.
The membrane produces a pint to a quart of mucus a day, which is flushed out of the sinuses by tiny cilia, or hairlike filaments. They help pass pollen, bacteria and viruses from the nose to the back of the throat, where they are swallowed and then dissolved by stomach acids.
For reasons that are not entirely clear, the sinuses of people with chronic sinusitis are often mottled with inflammation. The ducts swell, trapping mucus, viruses and bacteria inside. The dark moist hollows become ideal breeding grounds for infection. Frequently, the chronic swelling and infections cause polyps.
"No one is really sure what sets off the cascade of inflammation that makes some people sick", Dr. Krouse said. "We don't know why some respond to one treatment while others don't or why some symptoms bother some patients to distraction but are not noticeable to others. We are struggling to make sense of it. We're not even sure what this disease really is."
For years, doctors expanded the sinus openings with surgery, stripped away membranes and removed bony structures, known as turbinates, which are responsible for humidifying inspired air. Sometimes, the procedures created more problems than they solved. Turbinates, it turns out, are essential to the health of the chambers and are primary defenders against disease.
Still, some problems like polyps or anatomical blockages may call for surgery. Surgeons are finding that when procedures are necessary, a less aggressive approach often yields better results than the radical designing of the sinuses that was done in years past.
Nonsurgical treatments have included oral and intravenous antibiotics, antihistamines and decongestants, as well as oral and topical steroids.
Steroids work to calm inflammation, and some doctors find them effective. Often the only relief many patients receive is from prednisone, a powerful steroid.
"We began to see that we were not going to solve this puzzle with a better antibiotic, or a better procedure", Dr. Krouse said. "That points to inflammatory and immunologic processes, not surgical or infectious ones."
Researchers at the Mayo Clinic achieved a breakthrough in 1999, when they found that some inflammation was caused by an immune response to fungi in the nose. Patients and control subjects had many different species of fungi in the nose. But just those with chronic sinusitis have white blood cells, known as eosinophils, that are activated by the immune system, the researchers found.
Led by Dr. Jens Ponikau, they discovered that the immune system sends eosinophils to attack fungi. The eosinophils release a protein that irritates the membranes in the nose. The irritation remains as long as the fungi are present. A paper on their findings will be published in a peer-reviewed journal next month.
The Mayo team is treating patients with antifungal solutions. Clinical trials are continuing, and patients who have been treated have given encouraging reports. "But we have to settle in for the long haul", Dr. Ponikau said. It's a paradigm shift, a different way of looking at the disease.
Some doctors have succeeded with a class of asthma drug called leukotriene receptor antagonists. They work by blocking leukotrienes, substances that the immune system secretes in asthma and allergy attacks and that inflame the respiratory tract. Patients with sinus disease often have asthma, as well.
"Asthma patients who used these drugs found that their sinus symptoms were eased", said Dr. Michael Setzen, who has a practice in Manhasset, N.Y., and is an assistant clinical professor of otolaryngology at the New York University School of Medicine. "If it works, patients know it right away."
An asthma medication, Singulair, the trade name for montelukast, is awaiting approval from the Food and Drug Administration for allergy symptoms. Many doctors, however, prescribe it for sinus problems.
Dr. Alexander C. Chester, an internist in Washington, treats hundreds of patients with sinusitis. He recommends cutting dairy products from the diet. Eliminating milk was popular advice some years ago, but lost currency because the benefits could not be verified, Dr. Chester said.
In 10 percent of his patients, he said, eliminating milk products substantially improves sinusitis and all its symptoms. It is possible that less milk means less mucus, but researchers are unsure exactly why reducing milk in the diet is effective.
Dr. Chester and other experts also urge common sense. Patients with sinusitis should be evaluated for anatomical obstructions, (in those cases, surgery can help), allergies, and strength of the immune system, Dr. Krouse said, adding, "We need as much information on a patient-by-patient basis as we can get".
Dr. Benninger of Detroit asks patients to complete a questionnaire about physical, emotional and social difficulties. Routinely, patients report high levels of fatigue, depression and sexual dysfunction. "This disease is so much more than just its symptoms", he said.
Many doctors encourage patients to avoid wine and beer, which can cause passageways to swell. Smoking and tobacco smoke should also be avoided. The doctors agree that patients should exercise, drink enough water and irrigate their noses with a homemade saline solution. Many over-the-counter solutions have a preservative, benzalkonium chloride, that can be irritating and may paralyze cilia.
Some doctors also find promise in an over-the-counter nasal saline spray made with xylitol, a natural sweetener used in chewing gum and mints since the 1960's. Xylitol is also produced in small amounts in the human body in normal metabolism.
A recent study in Finland found that xylitol, a natural antimicrobial, was effective in reducing the ability of common respiratory bacteria, including Streptococcus pneumoniae and Hemophilus influenzae, to adhere to the mucous membrane.
The doctors who treat patients with chronic sinusitis are frustrated, too. "We're not even close to having all the answers", Dr. Setzen said. "Our big hope is that we can help these people who are nasal cripples. A functioning nose is essential to the quality of one's life."
Mayo Clinic Rochester
Thursday, September 09, 1999
Mayo Clinic Study Implicates Fungus as Cause of Chronic Sinusitis
ROCHESTER, MINN. -- Mayo Clinic researchers say they have found the cause of most chronic sinus infections -- an immune system response to fungus. They say this discovery opens the door to the first effective treatment for this problem, the most common chronic disease in the United States. (See graph.)
An estimated 37 million people in the United States suffer from chronic sinusitis, an inflammation of the membranes of the nose and sinus cavity. Its incidence has been increasing steadily over the last decade. Common symptoms are runny nose, nasal congestion, loss of smell and headaches. Frequently the chronic inflammation leads to polyps, small growths in the nasal passages which hinder breathing. "Up to now, the cause of chronic sinusitis has not been known," say the Mayo researchers: Drs. David Sherris, Eugene Kern and Jens Ponikau , Mayo Clinic ear, nose and throat specialists. Their report appears in the September issue of the journal Mayo Clinic Proceedings.
"Fungus allergy was thought to be involved in less than ten percent of cases," says Dr. Sherris. "Our studies indicate that, in fact, fungus is likely the cause of nearly all of these problems. And it is not an allergic reaction, but an immune reaction."
The researchers studied 210 patients with chronic sinusitis. Using new methods of collecting and testing mucus from the nose, they discovered fungus in 96 percent of the patients' mucus. They identified a total of 40 different kinds of fungi in these patients, with an average of 2.7 kinds per patient.
In a subset of 101 patients who had surgery to remove nasal polyps, the researchers found eosinophils (a type of white blood cell activated by the body's immune system) in the nasal tissue and mucus of 96 percent of the patients.
The results, the researchers say, clearly portray a disease process in which, in sensitive individuals, the body's immune system sends eosinophils to attack fungi and the eosinophils irritate the membranes in the nose. As long as fungi remain, so will the irritation.
"This a is potential breakthrough that offers great hope for the millions of people who suffer from this problem," says Dr. Kern. "We can now begin to treat the cause of the problem instead of the symptoms."
More research is underway at Mayo Clinic to confirm that the immune response to the fungus is the cause of the sinus inflammation. The researchers are also working with pharmaceutical companies to set up trials to test medications to control the fungus. They estimate that it will be at least two years before a treatment will be widely available.
The researchers distinguish chronic sinusitis -- sinusitis that lasts three months or longer -- from acute sinusitis, which lasts a month or less. They say that the cause of the acute condition is usually a bacterial infection.
Antibiotics and over-the-counter decongestants are widely used to treat chronic sinusitis. In most cases, antibiotics are not effective for chronic sinusitis because they target bacteria, not fungi. The over-the-counter drugs may offer some relief of symptoms, but they have no effect on the inflammation.
"Medications haven't worked for chronic sinusitis because we didn't know what the cause of the problem was," says Dr. Ponikau. "Finally we are on the trail of a treatment that may actually work."
Thousands of kinds of single-cell fungi (molds and yeasts) are found everywhere in the world. Fungal spores (the reproductive part of the organism) become airborne like pollen. Some people develop allergies to fungi. The new evidence from the Mayo study suggests that many people also develop a different kind of immune system response.
http://www.mayo.edu/comm/mcr/news_773.html (1 of 3)8/4/2005 7:44:12 PM
Contact: e-mail: newsbureau@...
IT SEEMS THAT THE MAYO CLINIC HAS TRIED TO SUPPRESS THE FINDINGS OF THIS SEPT. 1999 STUDY:
"The Diagnosis and Incidence of Allergic Fungal Sinusitis"
The original Mayo Clinic URL for this September 1999 study mysteriously "went dead", AS AT:
THERE IS REASON TO BELIEVE THAT "SOMEONE" AT THE MAYO CLINIC WANTS TO SUPPORT THE SURGEONS WHO ARE "TREATING" SINUSITIS, WHICH CREATES A MOTIVATION TO SUPPRESS THE FACT THAT 95% OF ALL SINUSITIS HAS BEEN PROVEN TO BE CAUSED BY FUNGAL ORGANISMS THAT CAN BE CURED WITHOUT SURGERY.
But other sources still show this study, as in the following three URLs:
The following abstract was at the Mayo Clinic URL:
BUT THAT URL NOW HAS A "Page Not Found" ERROR MESSAGE.
THE DIAGNOSIS AND INCIDENCE OF ALLERGIC FUNGAL SINUSITIS
J. U. Ponikau, D. A. Sherris, E. B. Kern, H. A. Homburger, E. Frigas, T. A. Gaffey and G. D. Roberts
Department of Otorhinolaryngology, Mayo Clinic Rochester, Minn 55905, USA.
OBJECTIVE: To reevaluate the current criteria for diagnosing allergic fungal sinusitis (AFS) and determine the incidence of AFS in patients with chronic rhinosinusitis (CRS).
METHODS: This prospective study evaluated the incidence of AFS in 210 consecutive patients with CRS with or without polyposis, of whom 101 were treated surgically. Collecting and culturing fungi from nasal mucus require special handling, and novel methods are described. Surgical specimen handling emphasizes histologic examination to visualize fungi and eosinophils in the mucin. The value of allergy testing in the diagnosis of AFS is examined. RESULTS: Fungal cultures of nasal secretions were positive in 202 (96%) of 210 consecutive CRS patients. Allergic mucin was found in 97 (96%) of 101 consecutive surgical cases of CRS. Allergic fungal sinusitis was diagnosed in 94 (93%) of 101 consecutive surgical cases with CRS, based on histopathologic findings and culture results. Immunoglobulin E-mediated hypersensitivity to fungal allergens was not evident in the majority of AFS patients.
CONCLUSION: The data presented indicate that the diagnostic criteria for AFS are present in the majority of patients with CRS with or without polyposis. Since the presence of eosinophils in the allergic mucin, and not a type I hypersensitivity, is likely the common denominator in the pathophysiology of AFS, we propose a change in terminology from AFS to eosinophilic fungal rhinosinusitis.
Rhinoplasty-risks, Informed-Consent DISCLAIMER by SURGEON
Editor's Note: Surgery, (i.e. rhinoplasty), is the "treatment" offered for sinusitis, but if an actual cure exists for sinusitis, (i.e. [DMSO + fluconazole]), then that surgery by definition is criminal butchery. (DMSO + fluconazole) is not an easy, overnight cure, but rhinoplasty is fraught with horrors. This surgeon's-disclaimer for rhinoplasty is clearly deceptive, concerning the time it can take to heal, after the surgery. See below, the term "LONG TIME", which should read "over a year"; but the term "long time" was obviously used to deceive the patient. In addition, the possible difficulties for the patient are publicly downplayed, (i.e. hidden), by these deceitful $urgeons, but they naturally have to reveal the below listed (not-so-rare) horrors of rhinoplasty in their legally-required, (INFORMED-CONSENT) disclaimer.
INFORMED CONSENT - RHINOPLASTY SURGERY
This is an informed-consent document that has been prepared to assist your plastic surgeon inform you, concerning rhinoplasty surgery, its risks, and alternative treatment.
It is important that you read this information carefully and completely. Please initial each page, indicating that you have read the page, and sign the consent for surgery, as proposed.
Surgery of the nose, (rhinoplasty), is an operation frequently performed by plastic surgeons. This surgical procedure can produce changes in the appearance, structure, and function, of the nose. Rhinoplasty can reduce or increase the size of the nose, change the shape of the tip, narrow the width of the nostrils, or change the angle between the nose and the upper lip. This operation can help correct birth defects, nasal injuries, and help relieve some breathing problems.
There is not a universal type of rhinoplasty surgery that will meet the needs of every patient. Rhinoplasty surgery is customized for each patient, depending on his or her needs. Incisions may be made within the nose or concealed in inconspicuous locations of the nose, in the open-rhinoplasty procedure. Internal nasal surgery, to improve nasal breathing, can be performed at the time of the rhinoplasty.
The best candidates for this type of surgery are individuals who are looking for improvement, not perfection, in the appearance of their nose. In addition to realistic expectations, good health and psychological stability are important qualities for a patient considering rhinoplasty surgery. Rhinoplasty can be performed in conjunction with other surgeries.
Alternative forms of management consist of not undergoing the rhinoplasty surgery. Certain internal nasal-airway disorders may not require surgery on the exterior of the nose. Risks and potential complications are also associated with alternative forms of treatment that involve surgery, such as septoplasty, to correct nasal-airway disorders.
RISKS OF RHINOPLASTY SURGERY:
With any type of activity there is inherent risk. An individual's choice to undergo a surgical procedure is based on the comparison, of the risk to potential benefit. Although the majority of patients do not experience these complications, you should discuss each of them with your plastic surgeon to make sure you understand the risks, potential complications and consequences, of rhinoplasty.
BLEEDING - It is possible, though unusual, that you may have problems with bleeding, during or after surgery. Should post-operative bleeding occur, it may require emergency treatment to stop the bleeding, or a blood transfusion. Do not take any aspirin or anti-inflammatory medications for ten days before surgery, as this contributes to a greater risk of bleeding. Hypertension, (high blood-pressure), that is not under good medical control may cause bleeding during or after surgery. Accumulations of blood under the skin may delay healing and cause scarring.
INFECTION - Infection is quite unusual after surgery. Should an infection occur, additional treatment, including antibiotics, may be necessary.
SCARRING - Although good wound-healing after a surgical procedure is expected, abnormal scars may occur, both within the skin and the deeper tissues. Scars may be unattractive and of different color than the surrounding skin. There is the possibility of visible marks from sutures. Additional treatments, including surgery, may be needed to treat scarring.
DAMAGE TO DEEPER STRUCTURES - Deeper structures, such as nerves, tear ducts, blood vessels, and muscles, may be damaged during the course of surgery. The potential for this to occur varies with the type of rhinoplasty procedure performed. Injury to deeper structures may be temporary or permanent.
UNSATISFACTORY RESULT - There is the possibility of an unsatisfactory result from the rhinoplasty surgery. The surgery may result in unacceptable visible or tactile deformities, loss of function, or structural malposition after rhinoplasty surgery. You may be disappointed that the results of rhinoplasty surgery do not meet your expectations. Additional surgery may be necessary, should the result of rhinoplasty be unsatisfactory.
NUMBNESS - There is the potential for permanent numbness within the nasal skin, after rhinoplasty. The occurrence of this is not predictable. Diminished, or complete loss, of skin sensation in the nasal area may not totally resolve after rhinoplasty.
ASYMMETRY - The human face is normally asymmetrical. There can be a variation from one side to the other, in the results obtained from a rhinoplasty procedure.
CHRONIC PAIN - Chronic pain may occur, very infrequently, after rhinoplasty.
SKIN DISORDERS & SKIN CANCER - Rhinoplasty is a surgical procedure to reshape the internal and/or the external structure of the nose. Skin disorders and skin cancer may occur independently of a rhinoplasty.
ALLERGIC REACTIONS - In rare cases, local allergies to tape, suture materials, or topical preparations, have been reported. Systemic, (bloodstream), reactions which are more serious may occur to drugs used during surgery and to prescription medicines. Allergic reactions may require additional treatment.
DELAYED HEALING - Wound disruption or delayed wound-healing is possible. Some areas of the face may not heal normally, and MAY TAKE A LONG TIME TO HEAL.
[Editor's Note: This "LONG TIME" is a DECEPTIVE, GROSS UNDERSTATEMENT.] Areas of skin may die. This may require frequent dressing changes or furthersurgery, to remove the non-healed tissue.
LONG-TERM EFFECTS - Subsequent alterations in nasal appearance may occur as the result of aging, sun exposure, or other circumstances not related to rhinoplasty surgery. Future surgery or other treatments may be necessary, to maintain the results of a rhinoplasty operation.
NASAL-SEPTAL PERFORATION - There is a possibility that surgery will cause a hole in the nasal septum to develop. The occurrence of this is rare. However, if it occurs, additional surgical treatment may be necessary, to repair the hole in the nasal septum. In some cases, it may be impossible to correct this complication.
NASAL-AIRWAY ALTERATIONS - Changes may occur, after a rhinoplasty or septoplasty operation, that may interfere with normal passage of air through the nose.
SURGICAL ANESTHESIA - Both local and general anesthesia involve risk. There is the possibility of complications, injury, and even death, from all forms of anesthesia or sedation used for surgical procedures.
Most health-insurance companies exclude coverage for cosmetic surgical-operations or any complications that might occur from cosmetic surgery. If the procedure corrects a breathing problem or marked deformity, after a nasal fracture, a portion may be covered. Please carefully review your health-insurance, subscriber-information pamphlet.
ADDITIONAL SURGERY NECESSARY:
There are many variable conditions, in addition to risk and potential, surgical complications, that may influence the long-term result from rhinoplasty surgery, even though risks and complications occur infrequently. The risks cited are particularly associated with rhinoplasty surgery. Other complications and risks can occur, but are even more uncommon. Should complications occur, additional surgery or other treatments may be necessary. The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee or warranty, expressed or implied, as to the results that may be obtained. Infrequently, it is necessary to perform additional surgery, to improve your results.
The cost of surgery involves several charges for the services provided. The total includes fees charged by the doctor, the cost of surgical supplies, anesthesia, laboratory tests, and possible outpatient hospital-charges, depending on where the surgery is performed. Depending on whether the cost of surgery is covered by an insurance plan, you will be responsible for necessary co-payments, deductibles, and charges not covered. Additional costs may occur, should complications develop from the surgery. Secondary surgery, or hospital day-surgery charges involved with revisionary surgery, would also be your responsibility.
Informed-consent documents are used to communicate information about the proposed surgical treatment of a disease or condition, along with disclosure of risks and alternative forms of treatment. The informed-consent process attempts to define principles of risk disclosure that should generally meet the needs of most patients, in most circumstances.
However, informed-consent documents should not be considered all-inclusive, in defining other methods of care and risks encountered. Your plastic surgeon may provide you with additional or different information, which is based on all the facts in your particular case, and on the state of medical knowledge.
Informed-consent documents are not intended to define or serve as the standard of medical care. Standards of medical care are determined on the basis of all of the facts involved, in an individual case, and are subject to change, as scientific knowledge and technology advance, and as practice patterns evolve.
Note: It is important that you read the above information carefully and have all
of your questions answered, before signing the following consent statement.
CONSENT FOR SURGERY, PROCEDURE, OR TREATMENT
1) I hereby authorize Dr. xxxxxxx, and such assistants as may be selected, to perform the following procedure or treatment: RHINOPLASTY SURGERY.
I have received the following information sheet: INFORMED CONSENT FOR
2) I recognize that during the course of the operation and medical treatment or anesthesia, unforeseen conditions may necessitate different procedures than those above. I therefore authorize the above named physician and assistants or designees to perform such other procedures that are in the exercise of his or her professional judgment necessary and desirable. The authority granted under this paragraph shall include all conditions that require treatment and are not known to my physician at the time the procedure is begun.
3) I consent to the administration of such anesthetics considered necessary or advisable. I understand that all forms of anesthesia involve risk and the possibility of complications, injury, and sometimes death.
4) I acknowledge that no guarantee has been given by anyone, as to the results that may be obtained.
5) I consent to the photographing or televising of the operation(s) or procedure(s) to be performed, including appropriate portions of my body, for medical, marketing, scientific, or educational purposes.
6) For purposes of advancing medical education, I consent to the admittance of observers to the the operating room.
7) I consent to the disposal of any tissue, medical devices, or body parts, which may be removed.
8) I authorize the release of my Social-Security number, to appropriate agencies, for legal reporting and medical-device registration, if applicable.
9) IT HAS BEEN EXPLAINED TO ME IN A WAY THAT I UNDERSTAND:
a) THE ABOVE TREATMENT OR PROCEDURE TO BE UNDERTAKEN
b) THERE MAY BE ALTERNATIVE PROCEDURES OR METHODS OF TREATMENT
c) THERE ARE RISKS TO THE PROCEDURE OR TREATMENT PROPOSED
I CONSENT TO THE TREATMENT OR PROCEDURE AND THE ABOVE LISTED ITEMS, (1 THRU 9).
I AM SATISFIED WITH THE EXPLANATION.
Signature of Patient or Person Authorized to Sign for Patient__________
Signature of Witness________________
[Non-text portions of this message have been removed]