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Silicone Kills

TL;DR - large-volume silicone injection kills healthy young men

I’m wading into this on my own page because when I heard of Tank/Jack’s sudden passing, it really sent me reeling - not because we were close, but because I’m an acquaintance of Dylan and a few of his household members. I know what it’s like to lose an emotional intimate suddenly, and I wouldn’t wish that on anyone. My initial response was that of sympathy and compassion because that’s what decent people do when a family experiences a loss.

The other thing that struck me - hard enough to make me stop what I was doing - was the reported mechanism of his demise: a “previously undiagnosed respiratory condition” that was rapidly fatal and untreatable in a modern medical context.

As some of you know, I’m living with lung cancer, and in the last year, I’ve had an intense education in oddball pulmonary conditions of the young and seemingly healthy, like me. The number of potentially fatal conditions that a young immunocompetent guy can develop or have worsen dramatically between Folsom and October 15th is pretty small and all are horrific.

I’m not an MD, but let me walk you through my thinking.

Jack looked good in photos from Folsom - specifically, he didn’t look blue-lipped, gaunt, bloated nor, most importantly, did he have clubbed fingertips. So he didn’t have something like congestive heart failure or end-stage pulmonary hypertension. He also had enough performance status to be mobile, so he wasn’t on death’s door by conventional measures. Lung cancer was right out - aside from being rare (but not unheard of) in young nonsmokers, you don’t go from “mild cough” to “dead” in two weeks.

So Jack presumably died of an acute respiratory illness - not something he’d been living with from birth or years. His exercise tolerance historically is well documented - people with profoundly diminished lung function typically do not crush it at the gym. Dying quickly from a lung problem is usually what is known in the literature as ARDS - acute respiratory distress syndrome. It’s like saying “organ failure of the lung”, and once you get to that stage, it’s commonly fatal - even if you’re young and healthy, it’s overwhelming.

So what could cause his ARDS? The two broad categories are inflammatory and infectious causes. Respectively, these are known as pneumonitis and pneumonia. Pneumonitis is an inflammatory response to lung insults, and pneumonia is a pneumonitis caused by lungs getting infected with a microorganism.

Pneumonia you develop while not hospitalized is routinely fatal if you’re very young, very old or very sick. The number of healthy young people who develop an untreatable pneumonia is vanishingly small. Jack was treated at a hospital with an exceptional pulmonary medicine program - I’m a patient there myself and they are fully prepared to handle even the direst situations. So barring some incredibly exotic superbug and a very late presentation, survival is more likely than not in the young and healthy. His similarly young and healthy family members living in close quarters aren’t symptomatic either. This puts lung infection on the back burner.

So now I’m thinking inflammatory pathology. What are the things that can cause an overwhelming bronchiolitis or pneumonitis that aren’t pneumonia and that can’t be successfully halted enough to let the lung tissue recover when someone is in a well-equipped hospital environment and was OK enough to walk around a few days before? It’s a super small list. Almost all of the causes of massive lung inflammation are either chronic in nature, extraordinarily rare or not relevant (my assumption was that he wouldn’t have industrial exposures to toxins, he didn’t have recent radiation therapy, etc). If it was something like a medication reaction or other brief exposure to a toxin, you can usually halt administering the causative agent and steroid the fuck out of the patient and they get better. If it was caused by sepsis, an infection outside the lung throwing off enough inflammatory factors to damage lung tissue, the steroids would help the lungs while the antibiotics or antifungals or antivirals got the fire under control. If it was a chronic inflammatory condition like lupus, it would be rare AF to have a flare this severe that wasn’t responsive to treatment. All these things are rare in a healthy young person.

So after pondering this, I was left with “What can cause a massive inflammatory response that is resistant to treatment and progresses to ARDS despite optimal medical care, that wasn’t impacting his life much two weeks ago?”

I was aware of Jack’s body mods - I have social media and two functioning eyes. I was instantly curious if, aside from the risks caused by hitting a vein during silicone injection, if there was an evidence base for silicone-induced bronchiolitis or pneumonitis months to years after the original large-volume injection of silicone oil.

It didn’t take long to come up with dozens of papers and case reports - the risks of lung disease caused by silicone oil migration have been understood since the mid 1950s, which led to the later development of encapsulated breast implants. Women who had capsule failures suffered similar injuries with remarkably similar courses of disease progress and death.

So Tuesday night, I speculated that the cause of Jack’s death would ultimately be determined as migrated silicone leading to bronchiolitis leading to ARDS and death. The reason nothing could be done is that there’s not a single pool of silicone that can be magically removed - it’s distributed through tissue and in pockets and will continue to insult the lungs beyond the ability to treat the inflammatory reaction. There’s no substitute for the human lung and transplants would be impossible due to the silicone oil throughout the body, the contamination found in silicone oils and the lack of mechanism to capture and remove it.

This was, of course, all speculation on my part. I’m no MD, I didn’t have access to the imaging, and I’m looking from the sidelines from very incomplete information.

This morning, I was shocked to receive a photograph of what I have good reason to believe is an authentic King County death certificate. I have personally known the source for over twenty years and have no reason to question his integrity or motives. I have the unredacted version and I alone obscured certain personally identifying information of Jack and other parties. I have not seen the underlying medical records nor have I used any protected information from any source.

The cause of death is precisely as I speculated: silicone-induced lung injury leading to pneumonitis, progressing to ARDS and death due to alveolar hemorrhage - the smallest air exchange tissue became so damaged it could no longer maintain a barrier between blood liquids and the gas in the lungs. The inflammatory response turned a gas-permeable membrane into a useless sieve.

This is tragic and senseless and awful. No one deserves to die in pursuit of an aesthetic “ideal”.

I’ve spent the past year since my diagnosis vocally advocating for lung health - I’ve begged people to stop smoking cigarettes, I’ve congratulated them for doing so, I encouraged people to avoid exposure to wildfire particulates and I remain committed to all these ways of protecting these vital yet under-appreciated organs. I admit I wasn’t aware of a lung angle to silicone body modification last week, in the same way I wasn’t aware I was at risk for lung cancer last year.

Today, that all changes.

My goal with this post isn’t to kink-shame anyone. My goal is simple: I want to make men aware that large-volume silicone injection can be fatal - not just during and immediately after the procedure - but as a ticking time bomb for decades to come. It is irreversible, a proximate cause of an untreatable clinical syndrome that can lead to a horrible death and there is no way to make it safe.

I’m not here to figure out what would lead someone to engage in extreme modifications, who did this to Jack or assign blame. There are people closer to this. I’m here to say that this happened, an MD signed her name to the diagnosis and that nobody can engage in “brand protection” activity to change it.

I recognize that by leaking this, I’m risking some social opprobrium from the brand and his fan base. I just don’t fucking care. I don’t attend circuit parties. I don’t do Folsom. I don’t need acolytes. I care about lung health for good and well-known reasons. I care about my friends grieving the loss of a good man. I care about men on the Internet I’ll never even meet that are considering this type of body mod and come across my words in years to come.

Jack, your death is not in vain. Regardless of the consequences, I and others like me will use this tragic outcome to warn others that large-volume silicone injection is potentially fatal even years after the last injection, and make it socially unacceptable to promote or glamorize it in any way.

Rest In Power, Jack