Melinda2

FN23. Plaintiff testified that she believes her career as a model would have continued to be successful without implant surgery. Plaintiff's photographs as a model had been published in Italian Vogue before the implant surgery. She stated, however, that in the 1980s, models were in greater demand if they had large breasts, and she felt she would be able to model bathing suits and make the clothes to be modeled fit better with breast implants.

FN24. See, e.g., Plaintiff's Exhibits 1.2(b),(c),(e),(f),(h), 1.1(e), & (i). A list of dates and countries where Plaintiff modeled is given in Defendant's Exhibit 1076.

FN25. Plaintiff submitted to the Multi-District Litigation Panel a list, dated December 27, 1994, of symptoms and health problems she has suffered. Defendant's Exhibit 1076. She testified to her best recollection when she first noticed these problems and if they persisted after the implant procedure.

Despite increasing physical problems, Plaintiff expressed to her mother that she did not want to rely solely on modeling as a career. Thus between 1990 and 1993, Plaintiff paid for flying lessons, in large part from her earnings as a model, with the goal of obtaining a commercial pilot's license and becoming an airline pilot. To this end, she enrolled in Nova University, also paying for the tuition with earnings from her modeling career, to obtain a college degree which she felt would make her more attractive to airline employers. [FN26] On April 2, 1992, Plaintiff obtained her commercial pilot's license. [FN27] Mrs. Barrow described, and Plaintiff confirmed, how during this time Plaintiff took flying lessons, attended college, participated in a 1992 beauty pageant, and continued to do some modeling, all while her health was declining and she suffered from constant fatigue.

FN26. Plaintiff's transcript from Nova University is Defendant's Exhibit 1084(d). See also Plaintiff's Exhibit 1.117bb.

FN27. Plaintiff's Exhibit 1.80(a).

*4 Over this period, Plaintiff, often accompanied by her mother, went to many doctors for her many developing health problems. The testimony of several of these treating health care providers was presented during the trial. For instance, Dr. John Gaffney, who had known Plaintiff since she was three years old and had treated her as a chiropractor from her childhood through the present time, was qualified as an expert in chiropractic holistic care and clinical nutrition. He testified that Ms. Barrow had been a healthy individual until around 1988 when she began to have fairly constant problems with her neck and back, neuromuscular skeletal infections, and fatigue, and, as time went on, developed problems with her immune system, diarrhea and digestive problems, and problems holding her weight. [FN28] Dr. Gaffney reviewed his records of Plaintiff's visits to him for treatment from 1970 to the present. [FN29] From 1970 to 1984, he saw Plaintiff twenty-seven times, or an average of two times per year, over a period of fourteen years, including three adjustments for complaints stemming from a car accident in California on December 10, 1984. Although he saw Plaintiff in 1984, 1985, and 1987, it was during an examination in August of 1990 that Plaintiff first complained of multiple and considerable pain in her back, head, neck, and other joints, which Dr. Gaffney felt was unusual for her. [FN30] These problems persisted with additional complaints, from 1990 to 1994, of weakness, circulation problems, patchy blue and white skin, discoloration in her legs, rashes, headaches, loss of weight, frequent sore throats, persistent immune system problems, ear, throat, sinus and urinary tract infections, back spasms, loss of concentration and memory, swelling, decreased range of motion in her extremities, neck and back pain and stiffness, diarrhea, joint pain, depression, menstrual cramps, PMS, and tenderness of her skin to light pressure and temperature. [FN31] Before a visit by Plaintiff on August 14, 1990, Dr. Gaffney stated that he found Plaintiff to be very healthy. By 1992, Dr. Gaffney testified, Plaintiff was a "pretty sick girl."

FN28. Dr. Gaffney's notes of his treatments of Plaintiff contain references to her weight as follows: January, 1982--107 pounds; August, 1991—114 pounds; February, 1994--104 pounds; July, 1995--115 pounds; January, 1996--119 pounds; and July, 1996--115 pounds.

FN29. Plaintiff's Exhibit 1.94.

FN30. Dr. Gaffney treated Plaintiff five times between 1985 and 1990.

FN31. In 1995, Dr. Gaffney saw Plaintiff sixteen times for these problems, although he felt that she was improving. He also saw her five times in 1996 and thirteen times in 1997. Plaintiff filed her lawsuit in New York in 1994. Following Plaintiff's implant surgery, many of the complaints of physical problems about which Dr. Gaffney testified were echoed in the testimony of Dr. Udita Jahagirdar, a specialist in obstetrics and gynecology who treated Plaintiff from July 1, 1986 through October 31, 1996.

Some of the other physicians who treated Plaintiff testified that they found that she suffered from Irritable Bowel Syndrome. [FN32]

FN32. Dr. Lyle Wadsworth, a Deland, Florida physician who is board certified in internal medicine and geriatrics and who has seen Plaintiff several times as a patient beginning on August 5, 1991, stated that he diagnosed Plaintiff as having Irritable Bowel Syndrome as early as August 5, 1991. Deposition of Wadsworth at 5-7. Dr. David H. Lebioda, board certified in internal medicine and gastroenterology, saw Plaintiff on June 10, 1994 on referral from Dr. Jamie D. Carrizosa. From her symptoms related to gastroenterology, Dr. Lebioda felt that Plaintiff could have anything from a benign condition such as Irritable Bowel Syndrome to Crohn's disease or cancer of the colon. Deposition of Lebioda at 4, 9, 13, & 18. However, Plaintiff canceled the colonoscopy he had scheduled to rule out inflammatory bowel disease, and the closest diagnosis he could give was Irritable Bowel Syndrome. Id. at 36-39 & 45. Dr. Lebioda disclaimed any expertise in the area of silicone toxic syndrome. Id. at 36. Dr. Patrick G. Brady, a board certified gastroenterologist, saw Plaintiff twice, once on October 6, 1994 and again on November 2, 1995. From tests, including a sigmoidoscopy, he determined that her blood and liver were normal and that her symptoms were most compatible with Irritable Bowel Syndrome accompanied by chronic anxiety and depression. Deposition of Brady at 5, 8-15, & 22. He, like Dr. Lebioda, recommended increase in her food intake and fiber content. On her second visit, he referred her to a specialist in eating disorders for psychiatric evaluation because of her chronic anxiety and depression and abdominal pain not symptomatic of malnutrition. Id. at 14-16. Dr. Brady was concerned about anorexia nervosa, although he did not give that diagnosis. Id. at 22. Dr. Brady testified that he did not treat eating disorders and was not well-versed in problems caused by silicone gel breast implants. Id. at 17 & 27-30. He reviewed the records of Dr. Ira Klein, a gastroenterologist who saw Plaintiff on referral from Dr. Andrew William Campbell, and testified that they reflected abnormal findings, such as mild gastritis, colitis, elevated protein, and others. Id. at 48-49.

On August 18, 1993, Melinda Barrow married Kyle Eric Furbee. [FN33] They moved to Lakeland, Florida where Dr. Furbee was building his practice as a chiropractor. However, Plaintiff's physical problems worsened after her marriage. Her husband testified, and Plaintiff and her mother confirmed, that within one week of their wedding, Plaintiff had to return to her parents' home in Deland so that her mother could take care of her. Dr. Furbee stated that for the first six months of their marriage, Plaintiff spent over fifty percent of her time with her parents because of her physical problems, which he described as stomach upsets, cramps when she ate, joint pains, and headaches. [FN34]

FN33. Photographs of Plaintiff's engagement and wedding are Plaintiff's Exhibits 1.2(i) & (j). Plaintiff also modeled her wedding dress. Plaintiff's Exhibit 1.2(m).

FN34. Dr. Furbee stated that he knew that Plaintiff had breast implants before their marriage.

Subsequent to the 1985 implant procedure, and, according to Dr. Penn, by December 30, 1986, Plaintiff had significant capsular contracture in both breasts. Plaintiff saw Dr. Penn at least once a year to treat the scar tissue which had formed around the implants, causing her breasts to become so hard that, she testified, at times she could not sleep on her stomach. Dr. Penn recommended that his patients take fairly high doses of Vitamin E and gently massage around the implant to reduce the possibility of capsular contracture on the theory that moving the implant around as the capsule forms over it would tend to keep the implant's space as large as possible. [FN35] Dr. Penn also performed a "squeeze," or a closed capsulotomy, a painful remedy which provided relief to Plaintiff for a time before the breasts became hardened again. [FN36] Closed capsulotomies were performed on Plaintiff on August 5, 1986, December 30, 1986, May 7, 1987, April 25, 1988, May 12, 1988, and January 6, 1992. [FN37]

FN35. In 1992 or 1993, Dr. Penn became aware that massage of the breasts might cause a change in the cohesiveness of the silicone gel in the implants. Nevertheless, he continued to recommend to his patients, including Plaintiff, that they massage their breasts after the implant surgery.

FN36. Closed capsulotomy is a technique used by physicians to attempt to break the scar tissue capsule around the implant during which the implant is held behind the breast and pressure is applied to the capsule to try to get it to release, or the physician squeezes over the capsule in an attempt to break the capsule tissue. Plaintiff gave written consents for these procedures. See Plaintiff's Exhibit 1.96 at 10622-27 & 10631. Dr. Penn testified that both capsular contracture and the closed capsulotomy procedure can be painful. Dr. Shons testified that Dr. Penn's treatment of Plaintiff in this regard with massage and the closed capsulotomy procedure was appropriate, although he admitted that he did not use the closed capsulotomy procedure in his practice because it was an uncontrolled procedure the objective of which was to create a defect in the fibrous capsule, and one could not control exactly where the defect would be.

FN37. Plaintiff's Exhibit 1.96.

*5 However, one breast developed a bulge, causing Plaintiff to become concerned. [FN38] On her inquiry to Dr. Penn in 1991 and again in 1993, Plaintiff stated Dr. Penn informed her that there was no evidence of rupture, that the bulge in her breast was caused by the edge of the implant and weakening of the capsule, and that the only thing Dr. Penn could do for this condition was to remove the implants and insert new ones. [FN39] When shown a picture of the bulge in Plaintiff's breast, Dr. Penn noticeably winced on the witness stand and stated that he did not expect a result like that to occur, nor had he warned Plaintiff that this might be a result of the implant procedure. [FN40]

FN38. Plaintiff's Exhibits 1.75(a), (d), & (r)(1-3). Plaintiff feared the bulge in her breast might be a cyst. A mammogram and MRI confirmed that the bulge was caused by the implant. Plaintiff's Exhibits 1.98 a & b. Dr. Wadsworth testified that on his physical examination of Plaintiff on August 5, 1991, he did not note a deformity of the breast. Deposition of Wadsworth at 28.

FN39. Plaintiff's Exhibit 1.75a is a photograph taken in 1994. Dr. Penn's postoperative photographs of Plaintiff were not taken until 1993 and are Plaintiff's Exhibits 1.59(a-e). Dr. Penn last saw Plaintiff in 1993. He explained that the scar tissue capsule which forms around the implant is irregular and can be thicker in some places. The closed capsulotomy does not always cause the capsule to release and can cause a bulge. Dr. Penn also stated that the bulge could be due to a weakness in the capsule. The parties dispute whether Plaintiff manipulated or pushed her breast to accentuate the bulge shown in the picture. However, Dr. Penn's notes reflect that on his examinations of Plaintiff on January 21, 1991, January 6, 1992, and May 29, 1992, he found an irregularity in Plaintiff's breast which felt like the edge of the implant. Dr. Penn's notes reflect that he found a slight irregularity on the medial aspect of one of the Plaintiff's breasts on one of her visits, but not to the degree reflected in the above referenced picture. In his office notes, Dr. Penn wrote that it appeared that the implant was protruding through a slight weakness in the capsule. He also testified that he found an irregularity in the medial aspect of both of Plaintiff's breasts caused because the capsule had not released when the closed capsulotomy was done so that there was more tightening in that area. In addition, both Plaintiff's husband and her mother confirmed that Plaintiff had a lump from the implant on the inside of one of her breasts. In March of 1994, Dr. Campbell took photographs of the folds apparent in Plaintiff's implants when she pushed up and stated that they resumed their shape when she released them. Further, Dr. Shons also testified that Plaintiff had a "slight deformity" in her right breast. To the extent that a factual issue is presented, the Court finds that Plaintiff had a bulge in her right breast caused by the implant.

FN40. In 1993, Plaintiff was refused further coverage by her health insurer. Dr. Penn wrote a letter contained in her records dated March 17, 1993, which he testified reflected accurately his view that the lump in Plaintiff's breast was an irregularity and an aesthetic problem and that there was no clinical evidence of rupture or other problem with the implant. Plaintiff's Exhibit 1.96 at 10632; Defendant's Exhibit 1089A. Plaintiff sent the letter to the insurer along with her letter dated March 29, 1993, asking the insurer to reverse its action. The insurer responded by letter dated May 6, 1993 denying Plaintiff's request, noting that Plaintiff had failed to report Plaintiff's mammogram, the bulge in the right implant, the capsular contracture, and Dr. Penn's closed capsulotomies as treatments. Defendant's Exhibit 1089A.

However, Dr. Penn recommended against removal of the implants and, according to Plaintiff, stated that since her particular implants were then no longer being made, Plaintiff should wait to have her implants removed because something new would come on the market. At no time did Dr. Penn recommend removal of the implants. In 1993, after Plaintiff saw a television show on problems with breast implants, Plaintiff called Dr. Penn who advised her that he thought the implants were "OK" and were not the cause of her physical problems.

Plaintiff did not model after October of 1993. In 1994, Plaintiff's physical ailments became so severe that she dropped out of college and stopped taking flying lessons. [FN41] In March of that year, Plaintiff and her mother flew to Texas to see Dr. Andrew William Campbell after Plaintiff had obtained his name from a silicone breast implant support group in Tampa, Florida. [FN42] Dr. Campbell performed tests, treated Plaintiff, and referred her to Dr. Fabian Worthing III upon her request to have an explant operation. [FN43]

FN41. Plaintiff testified that in 1994 she lost 25 pounds, had mucous coming out of her bowels, suffered from fatigue, had rashes on her breasts, had stomach problems, swollen lymph nodes, and sores in her mouth, had trouble breathing, developed broken vessels on her hands, and had other problems. Plaintiff presented photographs taken from January to April of 1994 reflecting her physical problems: mouth sores (Plaintiff's Exhibits 1.75(n), (cc), (i), & (j)); broken blood vessels (Plaintiff's Exhibit 1.75(h)); rashes (Plaintiff's Exhibits 1.75(o),(m), & (p)); bruising (Plaintiff's Exhibit 1.75(r-4)); and blotches on her legs (Plaintiff's Exhibits 1.75(y) & (z)). One of the most startling photographs is of rashes that are several inches wide and that extend from under each of Plaintiff's breasts to her abdomen. Plaintiff's Exhibits 1.75(k) & (1). This photograph appears faded unless viewed, as was utilized at trial, with an ELMO, a visual presenter video presentation unit.

FN42. Dr. Campbell is board certified in family practice and forensic medicine. His curriculum vitae is Plaintiff's Exhibit 1.87(g). Since 1985 he has specialized in immunotoxicology, the study of how chemical toxins affect the body as a whole and the immune system in particular. The records of his treatment of Plaintiff are Plaintiff's Exhibits 1.87(a) & (b).

FN43. On his examination of Plaintiff in March of 1994, Dr. Campbell stated that he found, among other things, objective indications that Plaintiff had tiny red petechial dots throughout her skin, hyperactive deep tendon reflexes, and swollen lymph nodes in three areas. She also had lesions on her hands and fingers, weight loss, and muscle wasting. During his testimony in reference to these conditions, Dr. Campbell referred to photographs in Plaintiff's Exhibits 1.75(h),(m),(o),(p),(q), & (r). After receiving the results of tests, it was Dr. Campbell's opinion that Plaintiff had infection as well as immune system stimulation due to her silicone gel breast implants. Dr. Campbell did a thermography to test the temperature of her skin and found elevated temperature indicating inflammation from the breasts through the lymphatic channels, symptoms which he felt supported this opinion. Plaintiff's Exhibit 1.87(c). Dr. Campbell testified that his tests revealed that Plaintiff had several different antibodies, including antibodies to 15 different fungi, 3 different kinds of parasites, and silicone, an elevated rheumatoid factor, and an actively stimulated immune system, all of which he felt were related to her silicone gel breast implants. He testified that her complaints of fatigue, stomach problems, mucous in her stools, constant sores in her mouth, sore tongue, weight loss, rashes, and tenderness in her shoulders were also related to her silicone gel breast implants. He prescribed medication and a nutrition plan and told her to avoid chemicals, chlorine, artificial coloring, preservatives, sugars, and non-natural fibers. Plaintiff refused Dr. Campbell's recommendation that she receive six weekly treatments per year of intravenous gamma globulin for the rest of her life unless there was substantial improvement in her condition or a cure. These treatments would have lasted four to six hours each, at a cost of $15,000 each year. The tests ordered by Dr. Campbell generated much testimony during trial. Dr. Jacques Caldwell, an expert witness for Defendant in internal medicine, rheumatology, immunology and allergies, was critical of both the tests and conclusions of Dr. Campbell, noting that the vast majority of tests that Dr. Campbell ordered had no medical indications suggesting the need for them, the number of tests ordered were excessive, and some of the tests were unusually expensive. For instance, Dr. Caldwell testified that Dr. Campbell's antifungal test was not a panel of tests used by anyone whom Dr. Caldwell knows, and the positive result just showed exposure to common fungi inhaled every day; it did not show a fungal blood infection. Dr. Brian Kotzin, an expert in immunology presented by Defendant, agreed. Dr. Lebioda testified that he was not sure this fungal test was valid because infections can leave positive antibodies, a result which does not mean the patient currently has infection, and further, he did not believe Plaintiff had bowel parasites when he examined her on June 10, 1994. Deposition of Lebioda at 40-45. Dr. Caldwell also scoffed at Dr. Campbell's thermogram, stating it showed nothing because it registered temperature from blood flow, and the blood circulating closer to the skin will appear a deeper red. Dr. Caldwell rejected the gamma globulin treatment Dr. Campbell had recommended as experimental, used to treat patients with life-threatening, drug-resistant immune diseases who have tried and been unsuccessfully treated with standard treatments, and outrageously expensive. He opined that Dr. Campbell's tests do not indicate any immune disorder in Plaintiff or show that she is hypersensitive to anything. Dr. Caldwell concluded that Plaintiff has no immune dysfunction whatsoever. Dr. Kotzin was also critical of the number and types of tests ordered by Dr. Campbell, stating that they were not customary with a patient presenting Plaintiff's symptoms. Dr. Kotzin stated that it would be usual to order a blood chemistry, a white and red blood cell count, an urinalysis, the sedimentary ("SED") rate test, an antinuclear antibody ("ANA") test, and a rheumatoid factor test. However, he stated, in twenty years he had never ordered an anti-striated antibody test and that it is unclear what this test determines. Further, he noted that the antiparietal cell antibody test is for pernicious anemia because of stomach damage, and Plaintiff had no sign to warrant this test. Dr. Kotzin testified that the anti-smooth muscle antibody test is used to determine the cause of liver abnormality, not to determine if the patient has an abnormality of the liver, and it is not used often at present because other tests are much better. He noted that the rheumatoid factor test results presented by Dr. Campbell showed a positive result while other laboratory results were negative. Dr. Kotzin testified that rheumatoid arthritis could not be the diagnosis based on these results because people without rheumatoid arthritis can have a positive rheumatoid factor on this test. Dr. Kotzin noted five established criteria for rheumatoid arthritis: (1) objective swelling; (2) stiffness in the joints, not the muscles, on both sides of the body; (3) rheumatoid nodules or lumps under the skin; (4) hand arthritis; and (5) a positive rheumatoid factor test. Dr. Kotzin stated that a patient must have four or more of these criteria over six weeks to be diagnosed as having rheumatoid arthritis. He criticized Dr. Campbell for using criteria in his diagnosis which were not generally recognized and testified that nothing indicated Plaintiff has rheumatoid arthritis. Further, the deep tendon reflex test Dr. Campbell performed from which he found hyperreflexia, or that the reflexes were more active than normal, cannot be used to determine or diagnose peripheral demyelinating neuropathy or the myelin of the nerves breaking down according to Dr. Kotzin. Dr. Kotzin stated that there is no evidence that Plaintiff has demyelating neuropathy. Finally, Dr. Kotzin testified that there is no evidence Plaintiff has autoimmune disease, systemic inflammation, or systemic illness accounting for all of her complaints. Dr. Kotzin found her lab test results were mostly normal, and no test identified a specific illness. For instance, Irritable (or Functional) Bowel Syndrome, in which the patient has diarrhea and constipation, has no organic cause to identify or explain it, and people without silicone gel breast implants have it according to Dr. Kotzin. Dr. Klein was also critical of the tests Dr. Campbell had run. He did his own blood tests and stated the results were normal. Deposition of Klein at 8-9 & 12-14. In particular, he found that Plaintiff was not anemic, her white cell count was not elevated, there was no evidence of infection, her SED rate was normal and excluded certain inflammatory, infectious disease, and that her chemistries were normal. He did a colonoscopy and ruled out Crohn's disease, Irritable Bowel Syndrome, and ulcerative colitis. Id. at 12-13 & 36-48. He testified that Dr. Campbell's laboratory work showed abnormal values which did not indicate a medical illness but instead indicated that the laboratory Campbell used did not know what it was doing. Id. at 56. In disagreeing with the results of the blood work done by Dr. Campbell, he stated that if Plaintiff had antibodies to almost every infectious disease known to man as shown in Dr. Campbell's laboratory results, she would be dead. Id. at 56 & 70.

On April 7, 1994, Dr. Worthing removed Plaintiff's two implants which were intact and not ruptured. [FN44] Dr. Worthing testified that the pathology report from the explant was not unusual and reflected dense scar tissue with foreign body reaction and crystalline foreign material in the capsule. [FN45] Dr. Worthing noted that the crystalline foreign material referenced on the pathology report is found generally only in women with silicone gel breast implants. [FN46] While he tried to remove all the free silicone in the capsule, he was not able to testify that he had removed all of the silicone from this area of Plaintiff's breasts. [FN47] In the course of the explant, he removed some of the Plaintiff's interior breast tissue, and since Plaintiff is very thin, he testified, the cosmetic deformity resulting to Plaintiff from the explant operation is more pronounced. [FN48]

FN44. Deposition of Worthing at 18.

FN45. Id. at22 et seq.

FN46. Id. at 69.

FN47. Id. at 64-65.

FN48. Id. at 54-55 & 70.

Mollie Barrow described her daughter in April of 1994 as being very sick, weighing below one hundred pounds, suffering from allergies, rashes on her chest, blotches on her legs, stomach upsets, and problems with her sinuses and her joints. She accompanied her daughter to Texas for the explant, and at trial she gave moving testimony about her daughter's condition after this operation. She stated that Plaintiff weighed ninety-two pounds, looked like a concentration camp survivor, and that Plaintiff felt that she was on her death bed. Plaintiff was extremely weak, depressed, and unable to care for herself. [FN49] For one month her mother changed her dressings, bathed her, washed and combed her hair, cut her food, and attended to her needs because she could not get up or care for herself. Plaintiff expressed to her mother that she felt she had received a double mastectomy.

FN49. When Plaintiff arrived home with her mother, her husband tried to help change her dressings in her parents' home. Kyle Furbee stated that he tried to hide how upsetting his wife's condition was but he was not successful. Mollie Barrow heard her daughter scream from her bedroom. When she ran to this room, she found Dr. Furbee with her distraught daughter crying over her husband's reaction to her condition. Plaintiff presented photographs of her condition at this time. Plaintiff's Exhibits 1.61(a) & (c).

*6 For several months after the explant procedure, Plaintiff continued to be very sick with bowel problems, severe stomach cramps, and little appetite. Her husband echoed her mother's testimony that Plaintiff remained very sick; in fact he felt that for the first three months after the operation she became worse. [FN50] She was very thin and weak with no strength, her skin was a grey color, and he feared that she would die from emaciation.

FN50. Dr. Campbell testified that it is not unusual for symptoms of silicone gel breast implant patients to become worse immediately after explant because the silicone gel is stimulated and more of it gets into the blood stream during the explant surgery.

Subsequent to the explant, Dr. Sandra Houston [FN51] also described her efforts to provide psychological treatment to help Plaintiff overcome her depression. [FN52] Dr. Houston noted that Plaintiff's depression was not only from the disease process, but also was from the threefold loss of her career, her goals, and her body image as being that of a physically attractive person. [FN53] After identifying the etiology for her depression as being a disease from silicone poisoning, Dr. Houston tried to get Plaintiff to take small steps to feel cognitively better about herself based on what Dr. Houston thought was feasible for Plaintiff to accomplish. [FN54] Dr. Houston testified that Plaintiff's depression was disabling, was secondary to her disease, and that her prognosis for Plaintiff in the future was poor. [FN55] Although Dr. Houston has seen small improvements in Plaintiff, she does not believe that Plaintiff will return to her pre-morbid condition or that there will be any marked change with her underlying medical condition. Dr. Houston testified that Plaintiff will need therapy for the rest of her life.

FN51. Dr. Houston is a clinical psychologist who treated Plaintiff in four sessions beginning in June of 1992 and who treated her again beginning on October 12, 1994 after the explant operation.

FN52. Dr. Houston testified that she was shocked by Plaintiff's appearance and would not have recognized her when she returned for psychological treatment after the intervening two years and after the explant. Not only had Plaintiff's physical appearance drastically changed, but also Dr. Houston described Plaintiff's lack of energy, optimism, independent spirit, and motivation, all of which had been present during their interaction in 1992. Instead, in her treatment of Plaintiff beginning in 1994, Dr. Houston found Plaintiff to be a fearful, dependent, introverted personality with few friends and no life goals, Dr. Houston's records of her treatment of Plaintiff are Plaintiff's Exhibit 1.97.

FN53. Dr. Houston testified to manifestations of this depression, inter alia, that Plaintiff was embarrassed by the way she looked, that her clothes no longer fit, that she had no desire for normal and healthy sexual and physical intimacy both because it was painful and because of the scars on her breasts, that although she was a very spiritual person, she resisted going to church because people stared and felt she had a contagious disease or AIDS, and that she was fatigued, had poor circulation, could not stand for long, and cried often.

FN54. In this regard, Dr. Houston recommended such things as massage as a way for Plaintiff to get in touch with and accept her changed physique, taking walks to the store to build up strength, going out to eat or to the movies, spending time with her husband's parents as well as with her own, taking art and creative classes, participating with her husband in building a new home, wearing padded bras, and giving away outfits to let go of her past image and negative reminders.

FN55. Dr. Houston elaborated that Plaintiff was in tremendous distress, vacillating between moderate and severe depression, that Plaintiff was honest, not malingering, and, if anything, Plaintiff would "fake" things as being good, presenting a positive image if she could. Dr. Houston found that Plaintiff had a number of physical complaints, above average intelligence, and not a great deal of "ego strength".