PMA: Phl has metabolic bone experts, but...

MANILA, Philippines - There are enough doctors in the country who can treat former President and now Pampanga Rep. Gloria Macapagal-Arroyo or “any patient with any metabolic bone diseases,” an official of the Philippine Medical Association (PMA) said yesterday.

PMA Board of Governor for Manila Dr. Leo Olarte said there are many experts on metabolic bone illnesses in the Philippines, contrary to the pronouncement of Arroyo’s camp.

He said bone biopsy, which Arroyo also reportedly needs, is a regular procedure done “almost daily” in the Philippines.

Olarte, who is also a lawyer, admitted, however, that “legally and ethically speaking,” it is the patient’s right “to choose her physician of trust and confidence, wherever that physician is.”

“It is also her constitutional right as a Filipino citizen to travel wherever she wants, except, however, if there is a legal restraint or prohibition from a competent court of law, after due process of law,” he said.

He said there is not one doctor who specializes only in metabolic disorder anywhere in the world.

Patients with this disease are taken care of by a team of experts, with an endocrinologist and orthopedic surgeon in the lead.

“An orthopedic surgeon treating a metabolic bone disease will, of course, refer for co-management and treatment of his patient to an endocrinologist. Thus, they both form a medical team in the treatment and care of patients with metabolic bone disease. This is the standard of medical care observed also in foreign countries,” Olarte said.

Olarte said there are enough doctors in the country who have adequate skills, experience and competence in handling patients with this disease.

“Medicine is so complicated and its specialties so vast, that no one physician can be master of all the medical specialties. The specialists only concentrate in one field of medical practice,” he said.

With regard to the bone biopsy that Arroyo will have to undergo, Olarte also said it is a “regular and usual orthopedic procedure done almost daily here in the Philippines.”

He said the PMA does not recommend the use of stem cell treatment for hypoparathyroidism or cervical spondylosis because “in any part of the world (it) is still in its infancy and experimental stage.”

Hypoparathyroidism is an endocrine disorder wherein the parathyroid glands in the neck are not producing enough parathyroid hormones, the most common regulator of phosphorous and calcium levels in the body.

Its symptoms include muscle cramps, pain in the face, feet and legs, brittle nails, cataracts, dry hair and dry scaly skin, and seizures.

Olarte said the rate of failure in this medical procedure “is still unacceptable.”

Olarte also warned Arroyo’s camp against “misleading” the public that there is no one competent enough to treat her in the Philippines because this would hurt the country’s image in the international community.

“PGMA (Arroyo) cannot therefore use the alleged absence of an expert in metabolic bone diseases in the Philippines or the perceived absence of any medical or hospital facility to treat her hypoparathyroidism, to prosper her intentions to seek medical treatment abroad, since we all have the competence and facilities to treat her metabolic bone disease in the Philippines,” he said.

San Juan Rep. Joseph Victor “JV” Ejercito suggested that instead of Arroyo going abroad to seek treatment from bone disorder specialists, she should just bring such doctors here to allay fears of evading prosecution for her numerous plunder complaints and a possible electoral sabotage charge from the Department of Justice (DOJ).

Justice Secretary Leila de Lima has refused to grant Arroyo permission for a biopsy and medical treatment abroad for her problematic neck bones, saying there is no life-threatening urgency for such procedures and that there are lingering suspicions on her true motives to leave the country.

Arroyo’s legal spokesman Raul Lambino, however, said it would be difficult to invite doctors from abroad to treat Arroyo.

“Getting an appointment with these very rare breed of medical experts in their own hospitals and clinics abroad is already very difficult. They don’t have to chase patients somewhere because countless come to them,” Lambino said.

“Even our local doctors here would not have the time to go house to house to treat patients. The latter have to go to the former’s clinics,” he said.

Arroyo’s spokesperson Ma. Elena Bautista-Horn said the Pampanga lawmaker has already missed two doctors’ appointments in Singapore last month.

Horn challenged critics to look for a metabolic bone biopsy expert in the country so that Arroyo need not go abroad.

‘Rare bone disorder’

A medical certification obtained by The STAR from Rep. Arroyo’s attending physician had revealed “the possibility of a rare bone mineral disorder.”

“As stated in the medical bulletins and various medical abstracts previously submitted on the current medical condition of former President and Congresswoman Gloria Macapagal Arroyo, there is improvement as far as the cervical spine surgery, but there is a possibility of a rare bone mineral disorder that may require a bone biopsy,” read the medical certificate signed by Dr. Juliet Gopez-Cervantes dated Nov. 3, 2011.

“As far as we know, there is no bone mineral disorder expert and/or metabolic bone pathologist in the Philippines,” Cervantes said.

Marilen Tronqued-Lagniton, spokesperson for St. Luke’s Medical Center, also said everything the government needed to know about Arroyo’s health condition is already in the medical abstract the hospital submitted to the family.

Lagniton said she believes Health Secretary Enrique Ona was given a copy of the medical abstract.

She said she could not discuss the medical abstract but she knows that “it’s the same with the medical bulletin” issued by Arroyo’s doctors to the media.

“We cannot just distribute that (medical abstract) to anyone. We have been very open about our bulletin. The doctors have explained beyond (their) normal statement,” Lagniton said.

In the last medical bulletin issued on Oct. 19, the doctors noted that Arroyo “had remarkable improvements.”

The bulletin said Arroyo “no longer” suffers from neck pain and her halo vest - the metal contraption which she initially wore to immobilize her neck and head - had been removed.

According to Dr. Mario Ver, Arroyo’s orthopedic surgeon, the former president has also stopped complaining of a shooting pain through her arms and hand, and feels no more weakness or numbness in her upper extremities - her original complaints before operation.

Arroyo first underwent spine surgery on July 29 to address the pinched nerve in the neck.

Four of her cervical vertebrae were replaced with titanium implants but these were later dislodged.

The former president underwent a second surgery to repair the implants but the reconstruction failed after doctors found that the cause of the implant displacement was her low calcium levels.

Last Aug. 23, the doctors successfully reconstructed the implants.

The reconstruction involved the installation of a seven-centimeter long “bone mess cage” in the front portion of Arroyo’s cervical spine.

The cage, which looks like a tube with grills, was filled with bone graft from Arroyo’s pelvic bones necessary for fusion or bone growth.

The doctors said the realignment of the spine has since been stable.

“There is no loosening, dislodgment or interruption of the implant,” the Oct. 19 bulletin read.

Dr. Bernie Laya, the hospital’s director for institute of radiology, also said that there is already “early evidence” of bone growth in the operated spine.

Arroyo’s halo vest has also been replaced with a “less rigid neck brace” and she is encouraged to do some “rotational head and neck movement.”

She also takes supplements to ensure good bone healing. - With Aie Balagtas See, Paolo Romero