The following was a letter, actually two separate letters from two persons I received from a lady. It was sent to me by e-mail. I then replied hurriedly to her. But their names were changed to ethically protect their identities as patients before I post their letters and my reply into my blog for educational purpose only.
First letter
Dear Dr. JB Lim,
I had this back problem (S4 & S5) which recur last year.
After the MRI, I was only put on observation and some physiotherapy. I secretly did some pelvic exercise like lying flat on my back, bending both legs (in crouching position) swaying from left to right and some light leg movements. This help tremendously in my healing process and I was back on my feet in a week.
The only thing that worries me is the jab which my family doctor gave me during my first treatment is still down there in my buttock. It's been there for 4 years now. This lump did not worry me until my cousin brother's wife had a pelvic and spinal bone recurring problem.
Even in Singapore there isn't much help or enough doctors to go about the operation. (Maybe only happen in that hospital.)
My question is how are we going to tackle this bone loss degeneration as osteophrosis normally attack women faster than men. My mother is 89, her back is now almost ''r'' shape but I don't hear her complaining much about her backache.
I guess the rest would also want your expertise reply as precaution is always better than cure. Please advice on the drug Tramadol administration and other side effects too.
Following is the extract of the mail.
Best regards always
Ms Christine (name changed)
Second letter
I was having a difficult time for the last 3 weeks or so after my wife had a recurring spinal bone problem and a pelvic bone problem which came on suddenly about 3 weeks causing her so much agony that she had to stop baby sitting and and wanted a specialist to attend to her immediately as she was in tears due to her pain.
I was having a harrowing time shuttling her to hospital for so many days while keeping my work in balance.
Just a brief outline of what she went through. Her family strongly recommended that she went back to see her old bone specialist who had operated on her before some 13 years ago but this doctor had retired. Her sister recommended the next best thing to do was to see a bone doctor in Mount Elizabeth Hospital (recommended by her boss). We were all hoping to seek early and fast treatment as she could not bear with the pain and was weeping everyday. X-ray and MRI scan was done at Mt. E and she was asked to go for Physiotherapy instead of surgery first to see if it works.
After about 4 days, nothing seems to work and it was waste of time, money and resources to go to Mt Alvernia hospital for this physio therapy. I now strongly suspected that there wasn't enough operating theatre time slot for her for that week and this doctor was playing for more time.
On the second appointment to see him, he finally agreed that 2 places on her body need to be operated on Spinal and Pelvic bone.
All these came about because of bone degeneration in her spinal and then there was this muscle tissue tear which were all having a friction or rubbing effect on her nerves thereby causing her to be in great pain whenever she stands, let alone walk. I even had to go borrow a wheelchair from a past neighbour who now stays in Ang Mo Kio for her to use.
My shock came when this so called specialist doctor admitted that he was not qualified to operated on back bone or pelvic bone and he only can do surgery on knee cap. I was disgusted deep inside. He only knows of 2 doctors in Singapore who can operate on Pelvic bone (One Private one in Mt.E but he was out stationed for another week and the other one was Doctor Paul Chang at SGH). We were left with no choice but to make appointment to see Paul Chang and had to go to SGH as a private hospital patient paying the higher private medical fees for treatment. Another setback was earliest appointment had to be a week later.
We could not wait for 1 more week as the Pelvic bone pain was almost killing her. Very strong pain killer was given to her so much so that she developed very severe skin rashes. Don't take this strong painkiller drug called Tramadol if it was ever prescribed for you. You may end up scratching yourself non stop from head to toes like a monkey and the rashes are like big mosquitoes bites on the whole body. She poured half a bottle of medicated oil on her body when the rashes were coming on that day.
Luckily for me, I contacted a friend who knew Dr.Paul Chang well and managed to squeeze in an appointment at SGH on the same day after seeing the Mt.E hospital doctor. Dr. Paul Chang gave her an injection to immediately neutralise the Tramadol effect on her and it works well. Next problem was the Operating theatre time slot for her has to be about 5 days later and again she has to bear with the pain again. They said we could only book B1 class bed for her otherwise if we insist on B2 wards the operation date could be as long as 4 to 6 weeks later as they only allocate for 2 B2 beds each day. What kind of medical infrastructure and facilities are we having in this First World country called Singapore?
It was another long nightmare for her to bear with the pain for 5 days before she was finally operated on.
The operation was actually strongly recommended to be aborted due to her persistent cough , but she had begged the doctors to operate on her immediately without any more delay. She was operated by robot with 2 doctors doing the operation just moving their hands near a computer screen. More like the latest Wii game console. It is called keyhole operation with smaller cut and smaller wound and therefore less bleeding.
She stayed for 2 nights at B1 ward before she was discharged. Total cost spend on all her medical so far was S$13,000 and still counting. She is now recuperating at home. She is in less pain now but she could not stand for long because a second operation on the spinal bone may be due soon depending on her coming appointment on 25th May with Dr. Paul Chang.
She admitted she still need another operation as the pain in her legs are coming from the back bone vertebra abnormal growth getting on to her nerves. Seems like there is another Part 2 of medical nightmare for me to go through with her.
Seems like I will not be able to go head north so soon. I will let you know again as there are times when my colleague will need my help at JB and I may just go up there without much planning. I will try my best to make a trip maybe on the 26th or 27th of this month.
Meanwhile you take care and I will contact you again.
Best Regards
William (name changed)
--------------------------------------------
Doctor JB Lim’s reply:
Dear Ms Christine (name changed to protect patient’s identity),
I am unsure if you needed my advice, or was it another person there called William (name changed to protect patient’s identity as given in e-mail) as there are two letters in your letter with back bone problems. I have just opened your mail, and I have made a very quick scan of both letters. I have not made a detailed study of both letters as yet as I have a lot of other reports attend to
Anyway, I am just giving you or your friend a very fast emergency reply since both of you seemed to be in pain with some back problem. I shall read your letter a little slower later for the details.
Wrong and Right Doctor:
I think your friend in Singapore has gone to the wrong type of doctors for spinal and bone problems. The best type of doctor to treat neuromuscular and skeletal pain such as spinal problems is the osteopath. I think William went to see an orthopedic surgeon in Singapore, which is not the right doctor to go to as they are only interested in operations, and more operations that’s all.
An osteopath or osteopathic doctor is the best alternative doctor to consult for backbone problems. This type of doctors is fully qualified who uses alternative medicine called osteopathy to treat such cases as spinal problems. They do not use powerful pain killers like Tramadol and other powerful drugs merely to suppress the problem like the doctor who treated William did in Singapore. Neither do they use surgery and other invasive methods. They just align the body and musculoskeletal systems into good shape and correct order to solve the problem.
Osteopathic Doctors are more appropriate:
Osteopaths employ manual therapies for the treatment of many muscles, bones and skeletal pains such as lower back pain with excellent results. They neither use invasive procedures like surgery, nor drugs to mask the symptoms. Instead, they use therapies like dietary, posture alignment, occupational advice, as well as counseling to help patients recover from illness and injury to minimize and manage pain and disease quite effectively.
Unsure if Osteopathic Doctors available in Singapore?
However, I am unsure if there are osteopathic doctors practicing in Singapore? But there are a number of American osteopaths and Australian university trained osteopathic doctors in practice here in Kuala Lumpur. They are alternative medical doctors who can do a very good job with all sorts of muscles, ligaments, muscle, spinal (backbone) problems without using all sorts of unnecessary surgeries, harsh drugs and pain killers.
Chiropactic Doctors:
There is also another kind of alternative doctors called chiropractors. They too are very good for this sort of problems. They treat by aligning the bones and musculoskeletal systems. It is very lengthy for me to explain all these to you. It takes a lot of my time.
Types of spinal disorders:
Briefly, there are many types of spinal conditions that can cause a lot of pain. Most of them are degenerative spinal diseases. Degenerative spinal disease is related to chronic wear and tear on the spine due to aging and physical activity. It can lead to a number of different spine disorders such as Herniated Disc. This includes the following:
• Cervical Herniated Disc
• Thoracic Herniated Disc
• Lumbar Herniated Disc
• Spinal Stenosis
• Cervical Stenosis
• Lumbar Stenosis
• Foraminal Stenosis
• Spinal Instability
• Osteoporosis (as in women in post-menopausal stage due to bone loss from hormonal imbalance)
• Osteomalacia (example in rickets)
Actually I cannot give you any elaborate advice via e-mails as I need to have a look at the patient, see his / her medical records, understand his / her medical history, lifestyles, dietary habits, body weight, genetics, age, gender, family history, current treatment given, medication, lab results, radiological scans (X-rays, MRI, CT, etc). Without all these, I really cannot diagnose and suggest any specific treatment. This is just a general discussion to your possible problem.
Tramadol:
As to your question about Tramadol, yes this is a very powerful analgesic (pain killer drug). It is much more powerful as a pain reliever than paracetamol (Panadol). In fact Tramadol belongs to the opioid group of drugs like morphine, but it is slightly less powerful and a little safer than morphine. But it is a narcotic-like pain reliever acting centrally on the brain and central nervous system and it is used for managing moderate to moderately severe pain.
Adverse Drug Reactions:
Unfortunately like all chemical drugs, Tramadol do have moderate to severe side-effects even though normally it is well tolerated. Some of these side-effects may include sweating, drowsiness, diarrhoea, constipation, appetite loss, nausea, breathing difficulties, tightness in the chest, restlessness, chest pains, disorientation, mood changes, swelling and redness of the skin, giddiness, swelling of the face, mouth, lips, etc, and in some cases as in William’s case, there is severe allergic reactions such as pruritus (itchiness), rashes and beehives.
I think William’s case was severe allergic reaction to Tramadol. This can subside by just withdrawing the drug, or by an injection of an antihistamine. Drugs are all chemical substances foreign to the body, and being a foreign chemical when ingested, the body reacts badly to some drugs by trying to reject them. That is how the body cries out with all these symptoms. The symptoms are just the body’s reactions trying to reject the chemicals.
Most drugs hence give side effects in one way or another. The only way is to take them off instead of trying to suppress the symptoms by giving yet another drug such as an antihistamine. To use another drug to suppress the symptoms due to another drug is exactly like sweeping dirt under a carpet. This was exactly what William received and underwent when another doctor gave him an injection to suppress the itch caused by the first doctor. This is the tragedy of conventional drug-based medicine. Mainstream hospital type of medicine is like that.
Alternatives modalities of managing pain:
There are so many much safer, non-drug ways to treat pain rather than giving harsh and powerful drugs like Tramadol. Non pharmacological and much safer ways are (examples):
• Acupuncture
• Aromatherapy
• Breathing exercises
• Biofeedback
• Hot and cold compresses
• Guided imagery
• Massage
• Self-hypnosis
• Transcutaneous Electrical Nerve Stimulation (TENS)
• Touch energy therapies
• Spinal cord stimulation
• Physical therapy
• Distraction therapy
• Laughter therapy, etc.
Drugs are foreign substances to the body:
I do not recommend drugs to solve health problem. Many drugs merely suppress the symptom temporarily, but in the long run damage the liver, kidneys, nervous system, haematological (blood) and circulatory systems. All drugs are like that. They only temporary suppress and mask the problem, but do not cure the disease. To properly treat a medical problem you need to treat the root causes, not suppress the symptoms with harsh and powerful chemical drugs.
Unfortunately that is how modern conventional medicine treats an ailment. The drug company works hand in glove with the medical profession to promote their products, because the doctor does not know how to treat without the drugs, and the drug industry depends on the medical profession to sell them to the patients, and the patient has to pay to both of them. Unfortunately I am from the drug industry as their Special Medical and Science Advisor, but I am extremely honest and very ethical about this.
Medical Professor who opted for Natural Medicine:
A very good and old friend of mine who is actually a medical specialist - a Professor of Psychiatry at the former University Hospital, University of Malaya, but now in private practice, recently told me he had the same knee and bone problem but did not respond to treatment using conventional medical treatment with drugs, surgery and pain killers. He then sought alternative natural therapies using a number of herbs, and nutritional approaches which other doctor relatives bought for him from Australia and New Zealand.
These natural medicines finally gave him a lot of relief. I also advised him further what to do. All these have helped him tremendously.
I think I have spent a lot of time writing this letter. I hope you appreciate the time and effort I have spent.
Relatives and colleagues at SGH:
By the way, my youngest brother Professor Dr Lim Yew Cheng, a Professor of Cardiothoracic and Vascular Surgery was previously from Singapore General Hospital (SGH) before he came here to the University Hospital, University of Malaya. He is now in Gleneagle Intan Medical Centre, Kuala Lumpur.
But one of my nieces, Dr Hsu Anne Ling, a Senior Consultant Respiratory Physician is still there at the SGH, Singapore where Willie was treated. I have other doctor friends also working at SGH.
I shall read your two letters later as I have other things to attend as it is now nearly 1:00 a.m. in the morning.
Regards,
Lim Ju Boo BSc (Physiol), Postgrad Dip Nutrition, MSc, MD, PhD (Medicine) FRSPH, FRSM
Special Medical & Science Adviser &
Head of the Technical Advisory Board
The Dynapharm Pharmaceutical Int’l Group
http://www.diamondinterest.com.my/technicalboard.htm
http://dng.com.my/
Reply from patient
Dear Doctor Lim
Thank you for the quick respond and your reply had greatly opened my choices of alternative medication for precautionary measures.
I shall forward your email to William separately.
best regards always
Christine
(This is not her real name to protect patient’s confidentiality. Professional ethics is observed)
Hi doc,
One slight change, it's William’s wife. Thanks so much.
best regards always
Christine
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