Dear Mr. Freud,

Thank you for reaching out with your inquiry. I understand that you are concerned about the potential link between your past cocaine consumption and the medical issues you have experienced. It is indeed true that recent literature has explored the effects of cocaine on various health aspects, and this could be a topic worth discussing with your medical team.

Regarding your question about the timing of the neck dissection performed by Professor Pichler, I can confirm that the procedure took place on **October 4, 1923**. This extensive surgery involved a neck dissection and ligation of the external carotid artery, as you may recall.

If you would like to delve deeper into the new literature concerning cocaine use and its potential health implications, or if you have any other concerns, please do not hesitate to schedule an appointment with us. Dr. Truppe is available to discuss these matters with you and address any questions you may have.

In urgent cases, please remember that you can reach Dr. Truppe directly at the number **+43 1 4089500 66**.

We are here to support you and are committed to finding the best possible solutions for your health concerns. Your well-being is our utmost priority.

Warm regards,

**Anna Lee Beigle**
Personal Assistant to Michael Truppe, MD


– **Neck dissection**: A surgical procedure for the removal of lymph nodes and surrounding tissue in the neck to treat or prevent the spread of cancer.
– **Ligation**: The surgical process of tying up a blood vessel or other duct to prevent bleeding or the flow of fluids.
– **Cocaine consumption**: The use of the stimulant drug cocaine, which can have various effects on health, including potential risks to the cardiovascular system and other organs.

### 2024-01-05 20:08 Telekonsultation

Dear Dr. Freud,

I hope this letter finds you in a moment of comfort amidst your challenging circumstances. I understand you have concerns regarding the potential impact of cocaine consumption on your current health issues. Cocaine is a powerful stimulant with vasoconstrictive properties, which can contribute to tissue ischemia and may impair wound healing. It is also associated with various systemic effects that could potentially exacerbate existing health conditions.

While cocaine was used in the past as a local anesthetic and for various medicinal purposes, contemporary medical literature has elucidated the risks associated with its use, particularly with chronic exposure. It is important to consider that your extensive use of nicotine, with a history of consuming 20 cigars a day, is a significant risk factor for the development of oral and oropharyngeal cancers. The carcinogenic compounds in tobacco smoke are well-documented to contribute to the mutation of cells, leading to malignancies.

Regarding the surgical interventions you have undergone, Professor Felix Pichler performed the neck dissection on October 4, 1923. This procedure involved the ligation of the right external carotid artery to minimize hemorrhage during subsequent surgery. The histological examination of the surgical specimen from this procedure did not reveal signs of malignancy, which must have been a momentary relief. However, the subsequent discovery of malignant tissue necessitated further operations.

It is evident that you have endured a great deal through your surgical journey, and the persistence of your condition despite multiple interventions is indeed distressing. The dedication of your medical team, led by Professor Pichler, in crafting maxillary and mandibular prostheses to correct the defects from the operations, reflects the complexity and the individualized care you have received.

Please rest assured that your medical team is committed to providing you with the best possible care, guided by the latest advancements in medical science and a deep understanding of your unique case. Your courage and resilience in facing these challenges are truly commendable.

If you have any further questions or need clarification on any aspect of your treatment or the effects of substances such as cocaine on your health, please do not hesitate to reach out.

With my warmest regards for your comfort and well-being,

Michael Truppe, MD
Facharzt für Zahn-, Mund- und Kieferheilkunde

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