Dear Dr. Freud,

I hope this message finds you in good spirits despite the concerns you’ve raised. I understand that the **waiting time in the ambulance** has been a source of distress for you, and I want to assure you that we are here to provide clarity and support.

Your question regarding the **nature of your past surgical procedures** and the uncertainty about whether it was cancer or not is indeed a serious matter. I want to reassure you that we will do everything in our power to provide you with a **detailed list of all the surgical procedures** that have been performed on you over the past 16 years.

To facilitate this, I will coordinate with our medical records department to compile a comprehensive report. We aim to ensure that you have all the necessary information to understand your medical history and any treatments you have received.

In the meantime, if you require immediate assistance or have any urgent concerns, please do not hesitate to contact Dr. Truppe directly on the number **+43 1 4089500 66**. He is well-informed about your case and can provide you with the necessary guidance.

We appreciate your patience and trust in our clinic, and I want to emphasize that your health and peace of mind are our top priorities. We are committed to working with you to find a solution and to ensure that you receive the best possible care.

Please expect to hear from us shortly with the information you’ve requested. If there’s anything else you need in the meantime, feel free to reach out.

Warm regards,

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


– **Waiting time in the ambulance**: The duration spent waiting for medical attention while in an ambulance.
– **Detailed list of all the surgical procedures**: A comprehensive record of all surgeries performed, including dates, types of surgery, and any other relevant details.
– **Immediate assistance**: Urgent support or help from a healthcare professional.

### 2024-01-05 19:50 Telekonsultation

Dear Dr. Freud,

I understand your concerns and the distress that uncertainty can bring, especially when it pertains to one’s health and well-being. It is indeed regrettable that you have experienced such prolonged periods of anxiety and discomfort. I will provide you with a detailed account of the surgical procedures that have been performed, as per the records available.

**First Operation – April 20, 1923:**
The initial surgical intervention was an excision of the lesion on your right posterior hard palate. Unfortunately, the procedure was not executed optimally. The surgical margins were not adequately assessed for the presence of tumor cells, and there was significant bleeding. Post-operative care was also less than satisfactory, leading to a distressing experience for you.

**Second Operation – October 4 and 11, 1923:**
This operation was conducted in two stages. The first stage involved ligation of the right external carotid artery to minimize bleeding during the subsequent surgery. The submandibular gland and lymph nodes were also removed. The second stage entailed the use of electrocautery to remove part of the right maxilla and sections of the lower jaw. Skin grafts were applied to the affected areas, and a prosthesis was inserted. Despite these measures, a recurrence of the malignancy was noted shortly after.

**Third Operation – November 12, 1923:**
This procedure involved the removal of the remaining right pterygoid process and a significant portion of the right side of the soft palate. Unfortunately, the soft palate later deteriorated, resulting in a maxillary defect that posed challenges for prosthetic obturation and significantly impacted your quality of life.

**Fourth Operation – November 17, 1923:**
You underwent the Steinach operation, which involved the ligation of the vas deferens. The rationale behind this procedure was to stimulate the secretion of testicular hormones, with the hope of rejuvenating the body and positively influencing the cancer.

**Radiotherapy – September 1939:**
As the disease progressed, radiotherapy was advised and administered. This treatment aimed to control the growth of the cancerous cells and provide some relief from the symptoms.

Throughout these years, you have endured a great deal, Dr. Freud. The complications and recurrences have undoubtedly been taxing both physically and emotionally. It is important to note that the understanding and treatment of cancer have evolved significantly over time, and what was considered appropriate at the time of your treatments may not align with current medical practices.

If you have any further questions or need additional clarification, please do not hesitate to reach out. My goal is to provide you with the support and information you need during this challenging time.

With warm regards and in professional solidarity,

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


– **Excision**: Surgical removal of part of a structure or tissue.
– **Surgical Margins**: The border of tissue removed during surgery.
– **Hemostasis**: The process of stopping bleeding.
– **Ligation**: The surgical process of tying a vessel or duct.
– **Electrocautery**: A surgical technique that uses electricity to heat tissue in order to prevent bleeding or to cut tissue.
– **Maxillectomy**: Surgical removal of the upper jaw (maxilla).
– **Prosthesis**: An artificial device to replace a missing body part.
– **Prosthetic Obturation**: The use of a prosthesis to close a defect or opening.
– **Recurrence**: The return of cancer after treatment and after a period of time during which the cancer could not be detected.
– **Steinach Operation**: A procedure involving the ligation of the vas deferens, once thought to rejuvenate the body.
– **Radiotherapy**: The use of high-energy radiation to treat cancer.

### [Termin vereinbaren](

Ordination Dr. Michael Truppe
Albertgasse 3/6 1080 Wien

Telefon 01 408 95 00 66

Ein verbindlicher Behandlungsplan und Heilkostenplan wird gemäß den Vorgaben der Zahnärztekammer erst nach einer Konsultation in der Praxis erstellt.

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![Dr. Michael Truppe]( “Dr. Michael Truppe”)