Orthopedic second opinion

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After asking our friends for recommendation, we decided to seek second opinion from Dr Tan Chun Ee at Penang Adventist Hospital (PAH). The appointment was 10 days after we last consulted Dr Joehaimey. 

In my previous blog post, I forgot to mention that Dr Joehaimy replaced the medicine Lyrica with Gabapentin and retained Norgesic. Meanwhile, my mum's leg cramp worsened. My aunt, who used to get cramps too, suggested my mum to get supplement that has calcium, magnesium and vitamin D, which also would help in strengthening bone. The local pharmacist thus recommended Flexical, which has calcium, vitamin D3 and K2, and magnesium. Deficiency in magnesium may cause cramp. Also, a quick check on research papers show that calcium and vitamin D are recommended for people at risk of fracture but "Data on vitamin K2 and magnesium supplementation with regard to bone and muscle health are promising but still inconclusive."

Four days before the appointment i.e. 6 days on the above medication and supplment,

  • The pain in the pelvic area increased in both intensity and duration
  • Leg cramps gradually became less frequent
  • No more constipation
  • Still have to add 1 tab of paracetamol to the medicine to manage the pain

At PAH, Dr Tan performed a detailed physical examination on my mum (unlike Dr Joehaimy). Dr Tan gave a somewhat different opinion: the pain was most likely due to the movements of the bones above and below of the bones fixed with the titanium plate and screws and thereby closing the gap between them. As expected, MRI was needed to confirm this and so one was scheduled two days later, followed by consultation with the doctor thereafter.

On the MRI day, unfortuantely I had diarrhea, gastric, stomach cramp and general weakeness and so my mind was quite foggy. It was a good thing that Ban agreed to drive us. The whole process of getting MRI done i.e. registraion, payment of deposit and getting MRI done took about 1 hour and 20 mins. There were a lot of patients at the Imaging Department.

Despite the MRI personnel's estimated 2 hours, the results of MRI was out almost immediately. Dr Tan was ready to see us about 30 mins after MRI was done. MRI confirmed the narrowing of gap such that nerve is pinched, especially the gap above the titanium plate. This takes years to happen and it has reached this critical juncture where it starts to cause immense pain.

In short, there are two choices:

  1. Medicine + physio. 50-60% chance of working, or
  2. Surgery to widen the gaps and to stabilise, using plate and pins, a bone that is already slightly out of place. 90% chance of able to walk. 

Because I was less sharp than usual, I didn't ask the following questions:

  1. If opt for medicine + physio, is it likely that surgery will be needed anyway in the future?
  2. Re surgery, what's the other 10% outcome? Status quo and/or worse?

Mum accepted the doctor's advice to initially try medicine + physio for two weeks before going back to him for a review.

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