'GMA disorder could become permanent'

MANILA, Philippines -  The rare ailment troubling former President and now Pampanga Rep. Gloria Macapagal-Arroyo could become permanent and leave her debilitated for the rest of her life if untreated in three months, her doctors said yesterday.

The doctors’ assessment was one of the arguments raised in a 40-page petition by the Arroyo camp before the Supreme seeking the cancellation of three immigration watchlist orders issued by the Department of Justice on the former president.

The lawmaker first underwent surgery on July 29 at the St. Luke’s Medical Center in Taguig City for a painful condition called cervical radiculopathy, caused by worn-out discs as well as extra bone formations or bone spurs that exerted pressure on her spinal nerves and displaced some of her neck bones.

However on Aug. 9, during a required post-operation checkup, it was discovered the titanium implants supporting Arroyo’s neck and spine had been dislodged. The following day, she underwent a second surgery, which took 12 hours.

The doctors removed the dislodged implants but decided against replacing them at that time. To fuse together the back part of her spine, the surgical team put screws and rod and took bone grafts from her pelvic bone, the petition said.

The medical team also installed a halo vest on the 64-year old Arroyo to limit the movement of her head and neck.

“After the second surgery, the surgical team consulted with Dr. Randy Puno, a renowned orthopedic surgeon in the US via teleconference and discussed the causes of the dislodgment of the implants. After much discussion, it was the consensus that the principal cause of the dislodged implants could be hypoparathyroidism, a rare ailment which becomes permanent unless cured in about three months’ time,” the petition read.

A third surgery, which took six hours, was performed on Arroyo to replace her original implants.

“The doctors opined that the operation was successful but full recovery, in petitioner GMA’s case, will take more than the usual eight months to heal – this because the bone grafts and the titanium implants in petitioner GMA’s neck and spine cannot ensure bone growth within that period of time due to the uncertainties caused by her hypoparathyroidism,” the petition stated.

Hypoparathyroid lowers the production of parathyroid hormone, which regulates calcium levels in the body. Unregulated production of calcium affects bone formation and could cause convulsions, muscle spasms, pain and neurologic deficits, doctors said.

Her doctors at the SLMC diagnosed Arroyo to be suffering from metabolic bone disease and osteoporosis due to hypoparathyroidism with electrolyte imbalance and Vitamin D deficiency. They have also recommended a bone biopsy. Arroyo’s spokesperson Ma. Elena Bautista-Horn said the lawmaker wants to have the bone biopsy performed abroad. Her husband, Jose Miguel Arroyo, earlier said they were considering stem cell treatment for her ailment.

Her colleagues in the House of Representatives earlier granted her request for medical consultations in Germany, Italy, the US, Singapore and Spain from Oct. 22 to Dec. 5.

Arroyo has pending requests for appointment with doctors from the University of Alcorcon in Spain and the University of Aachen in Germany, the petition stated.

Bautista-Horn said that while Arroyo may be recovering from the surgery, her suspected bone disease might be hampering full recovery and might degenerate into a life threatening condition.

She claimed the former president had already missed several appointments with doctors due to delays in her request to seek medical treatment abroad. One of her cancelled appointments was with doctors at the Mt. Elizabeth Hospital in Singapore.

List of bone experts

For all her troubles with her neck and spine, Arroyo may seek relief from anyone of the country’s bone experts whose names are on a list that the Philippine Medical Association (PMA) is willing to provide her.

“There’s no problem with that. I can provide them with a list. They really cannot say that we don’t have experts here,” said PMA Board of Governor for Manila orthopedic surgeon Dr. Leo Olarte who is also a lawyer.

Last Sunday, Olarte debunked Bautista-Horn’s pronouncement that there were no bone disease specialists in the Philippines.

“Actually anyone can see the lists in the websites of Philippines Society of Endocrinology and Metabolism and Philippine Orthopedic Association. They can check if they want,” Olarte said.

Aside form bone biopsy, Olarte said Arroyo may also try “radioisotope scan,” another “non-invasive” procedure.

“The bone biopsy, in my personal opinion, is only an option. She does not have to undergo bone biopsy (that requires an operation). We have radioisotope scan that can take the place of bone biopsy,” he maintained.

Farlex’ online “The Free Dictionary” defines radioisotopes scan as a “two-dimensional representation of the gamma rays emitted by a radioisotope showing its concentration in a body site, such as the thyroid gland, brain, or kidney.”

The radioisotopes used in diagnostic scanning may be administered intravenously or orally.

Bone biopsy, on the other hand, involves the “removal of a piece of bone for laboratory examination and analysis.”

“Bone biopsy is used to distinguish between malignant tumors and benign bone disease such as osteoporosis and osteomyelitis,” the website stated. 

For an endocrinologist from the UP College of Medicine, Arroyo does not need to leave the country to have her condition checked and treated.

Dr. Nemencio Nicodemus Jr., who is also director of the Philippine Society of Endocrinology and Metabolism, said the metabolic bone biopsy being sought by the Arroyo camp can be done in the country by local doctors.

“It (procedure) doesn’t need for the person to go out of the country,” Nicodemus explained at a health forum sponsored by the Philippine College of Physicians in Quezon City.

He said the bone biopsy may be performed in the Philippines and the specimen examined in the country or sent abroad if necessary. “It’s something done in the Philippines,” he stressed. “Hypoparathyroidism is a rare condition in which the parathyroid gland secretes abnormally low levels of parathyroid hormone,” Nicodemus said. He said even the procedure of tracing the root of Arroyo’s condition can be done in the country.

“An operation is not needed to treat it. Operation is not really a part of the interventions,” Nicodemus said. with Sheila Crisostomo and Reinir Padua