The following is a guest opinion article from Doc Martyn. His opinions and advice are entirely his own and may not necessarily be those of The Pattaya News Company Limited. His contact information can be found at the end of the article.
1. Robert, a recently retired 64-year-old English Farang, came to see me on January 15, 2024. His swollen ankles caused his waddling, antalgic (to avoid pain) gait.
He used to be an elite football player then a builder and he is now a singer, who, ankles aside, appeared to be relatively healthy. But appearances can be deceptive.
On examination: his ankles were swollen and painful, see photo 1-4. His lower legs were swollen with pitting oedema. He was hypertensive, BP 155/100. He had a pansystolic murmur in his heart.
He was allergic to penicillin.
2. In recent Medical Bytes, I have written about the importance of taking a full medical history. In Robert’s case, I asked him if he had Rheumatic Fever (RF) as a child. ‘Not to my knowledge’ was his response. I then asked him how old he was when he had his allergic reaction to penicillin; ‘about 5 years old’. I asked if he was ill when he had the reaction. ‘Very’ was the reply. He recalled being hospitalised for weeks, with ‘tubes in his abdomen/chest’.
With his penicillin allergy, his serious illness as a child and the damage to his Mitral Valve, I confidently made the diagnosis of Rheumatic Fever (RF).
RF is caused by Streptococcal Pyogenes infection of the throat, see photo 5. It is an immune disease which usually starts 2-4 weeks after the throat infection. It can damage joints, the skin, the heart and the brain. Predominantly, it affects children 5-14 years of age.
This is an example of the importance of taking a good medical history, one of the arts of medicine. Today, the correct diagnosis would have been difficult to establish using blood tests, ultrasound, Xray, CT scan etc, the science of medicine.
3. We then focussed on the pain in his ankles and his hypertension.
Robert had suffered intermittent joint pain and gout for about 10 years. His current ankle pain was from gout. He had inflammatory gouty arthritis in both ankles caused by hyperuricaemia, excessive uric acid in his blood: uric acid 11.2 mg/L (normal 0-5.0mg/L).
His blood pressure was elevated and inadequately managed. Indeed, when he first arrived in Thailand, he was hospitalised with a systolic blood pressure over 230mmHg!
4. The reason why Robert’s hypertension and gouty arthritis was out of control: Prior to leaving the UK he had engaged (paid in advance GBP 500) for 10 treatments with a Chiropractor. The Chiropractor reassured him that using spinal manipulation he would cure all of Robert’s medical ailments and that he should stop all medication. In accordance with this advice, Robert ceased his prescribed medication, which resulted in his admission to a Thai Hospital and the troublesome gout in his ankles. This deregistered American Chiropractor, who is now practicing in the UK, is a menace and a danger to his clients.
5. At this point, Robert asked me about Stem Cell therapy for the gout in his ankles. He had been offered this treatment by a clinic in Jomtien.
Thailand has been quick to adapt to stem cell therapy, especially for the medical tourist industry. It is now ‘leading the charge’ in Asia. But the results remain anecdotal, lacking empirical evidence. Further, the promotional material is misleading; see the internet material on ‘Osteoarthritis and gout arthritis therapy’ provided by the Regeneration Centre of Thailand.
6. I reviewed and altered Robert’s medication. With appropriate treatment, Colchicine and Allopurinol, his gouty arthritis settled rapidly. Within five days, as the uric acid crystals dissolved, his ankle pain settled, as did his antalgic gait, obviating the need for Stem Cell Therapy.
The cost of his treatment; THB 900 for 3 months.
The cost for the Stem Cell therapy; THB 20,000 per ankle per treatment.
7. Robert received two opinions that were incorrect and may have caused him harm.
The first was afforded by the Chiropractor. Ceasing all medication was profoundly wrong advice, that could have caused a serious stroke, a heart attack or even heart failure. Potentially, this recommendation could have been fatal.
The second was afforded by the Stem Cell therapist. Giving Stem Cell therapy for gout may or may not heal post gout joint damage, but it will not reduce the elevated uric acid level causing the gout. Therefore, the treatment would have failed. In addition, Robert’s own Stem Cells were mobilised by the gouty arthritis; see Medical Bytes No 98: “Look after your Stem Cells and they will look after you”, dated 9/11/2023. Therefore, he did not need Stem Cell therapy.
8. In medicine, when money is concerned, never blindly follow the advice of your therapist. Unless you know and trust your therapist, remain sceptical. If you are unsure, always request scientific data to support their opinion and proposed treatment. A medic with nothing to hide will have nothing to hide, and supportive evidence will be offered freely.
“Beware the medical advice you heed.”
