A Challenging Medical Appeal

by Tilak S. Fernando

This appeal is directed to all eminent medical professionals to seek medical help to alleviate the amount of suffering undergoing for the past several years by one of your own eminent medical colleagues and a good friend of mine in London as I am pretty certain that there is someone out there to help my friend .

He has gone through every rack of medical care in the UK, having gone through the best and the cream of physicians, surgeons and neurologists. He has had Physiotherapy, Ultra sound, Tens, Anti-depressants, Anti-epileptics, Cortisone injections and oil applications to get over the pain he is constantly suffering from but so far only Codeine Phosphate gives him even a trace of relief from pain. He has not had acupuncture or any other more recent alternative therapies. Since the UK surgeons have ruled out further operations, having had no results at all on two previous surgical attempts ( two L5/S1 Microdiscectomies within a period of two weeks), my friend is willing to experiment on anything, seek any form of alternative therapy for the mere relief of the agonising and constant pain he is suffering from for the last few years. This is an open appeal and more or less a medical challenge to any sympathetic and understanding fellow medical person anywhere in the world.

My friend is currently suffering from Sciatic pain in his right buttock, lateral to right knee, lateral to right malleolus, around the right ankle and last two toes of right foot. As a consequence, most of his waking time is restricted with varying severity of pain. Codeine Phosphate suppresses his pain a little but the slightest walking he has to do, even for a call of nature, aggravates the pain! Sleep used to relieve the pain until recently but of late, sleeping on his right side as well as prolonged sitting down aggravates the pain. He also suffers from rather trembly lower limbs lately.

A main drawback is his inability to use his right upper limb on day-to-day activities, particularly writing, which despite no loss of power is associated with mild rigidity. The upper limb pain runs down right side of neck, right shoulder and ulnar compartment of the right upper limb. He does not swing the right upper limb in walking; keeps it in semi-fixed position usually. Right hand too shows a mild claw.

Associated problems:	
Labile hypertension 
Left ear tinnitus
Gastritis -	         
Trembling of lower limbs  ( particularly the right operated limb) - recently.
Difficulty in getting up      -  recently
Pain in dorsum of right thigh on standing for long periods or walking - quite recently.
Palm-sized area of numbness above right knee laterally transiently comes on with walking or standing for longer periods - quite recently

In 1996 he sought osteopathic treatment for developing a sore bottom if he did gardening continuously for two days. Twenty-four hours after osteopathic 'manipulations' on his back he developed a sciatic pain on his right side. Subsequent visits to the same osteopath and other chiropractioners did not do any good or cure the pain. Subsequently, when a neurosurgeon found on a myelogram the non-visualisation of the right S1 nerve root and the loss of right ankle jerk a decision was taken to operate on a small prolapse, which was visible on a previous MRI, scan.

On 6 May 1998 a microdiscectomy operation was carried on Right L5/S1, yet it could not eradicate the sciatic pain even for a day after surgery! Suspecting a re-prolapse the neurosurgeon re-operated on the patient on 20 May 1998, a fortnight after the first operation. Tragically even the second attempt of surgery did not do an atom of help in removing the pain he was suffering from.

From June 2001 the patient has been seen by all possible eminent Neurologists and has had the best of medical facilities in the UK, through BUPA membership, yet no one has been so far able to pin point and diagnose his ailment. The nearest the experts have come so far is that they suspect ' it could be R. Hemi-Parkinsonism'. However, latterly they have come out with the theory that ' it is not Idiopathic Parkinsonism'.

The patient is being empirically treated at present with Amantadine 100 mg b.d. Prior to taking Amantadine he was treated with Sinemet but had to withdraw it due to the dystonic side-effects of Sinemet, which the patient could not tolerate. Amantadine at least gives him a little help to walk even with pain!

All MRI scans show a modest degree of spondylosis. The very latest MRI scans show extensive fibrosis following surgery and surgeons in the UK are hesitant to re-explore, having failed twice! The patient is on the following medication at present on a regular long-term basis as follows:

Atenolol (Tenormin) ; Losarton (Cozar) ; Bendrofluazide ;Doxazosin (Cardura) ; Amantadine (Symmetrel); Codeine Phosphate ;Betahistine ( Serc) ; Diazepam ( Valium); (serc); Diazepam;Ranitidine ( Zantac)

Amantadine jacks up blood pressure (when controlled 130/90) but at present he does not want to give it up and try an Agonist (like Ropinirole) as it helps him at least walk a little. On the other hand complete withdrawal of Amantadine is also difficult and it has to be done on a gradual basis. Almost daily he has to use a Dulcolax suppository for severe constipation (Lactulose does not help).

The unfortunate aspect of this case is that although his diagnosis is not certain and he has to be treated empirically: he cannot mobilise himself at all without an effective anti-parkinsonian drug, which is Amantadine presently. Staying without any anti-parkinsonian drugs is unthinkable as he becomes completely immobile without one. Adding a further drug Doxazosin and administering anti-hypertensive drugs alongside Amantadine counter the BP rise of Amantadine.

His current medical advice is to gradually go off Amantadine, give a week free of drugs and start on Ropinirole on a starter pack but there is no guarantee that it will meet with success or give less side effects.

So, this is the tragic case or the fate of an eminent and highly respected doctor, in Sri Lanka at first and a Consultant in the National Health Service later, a Director of Post Graduate Education in the UK and one who has received a NHS Distinction Award for meritorious work in the National Health Service in the UK. He has given hope, reassurance and peace of mind to thousands of patients by his dedicated work focusing only on a single pointed motive - purely to alleviate the human suffering, yet today it is so sad to see him, of all people, as a victim, despite having so many renowned medical professors, surgeons and specialists in a most advanced health service in the world .

This appeal, therefore, is to anyone who can understand the symptoms detailed above and who is willing and able to help him, be it by Acupuncture, Alternative medication, Aurveda or even through meticulous spiritual or religious approach. He is eagerly awaiting to hear from you - from anywhere in the world - just to get rid of his agonising and continuous pain and say good bye to the amount of drugs he has to input to his system at present.

Any volunteers may initially contact me on my e-mail: Tilakfernando@aol.com or Tilakfernando@hotmail.com.