L - RAMBO - ONE THAT GOT AWAy,

18th June 2014
Ram Krishnaswamy’s Medical History:


This is something I prepared for GP Dr Collin Chu to get a second opinion on my general health.


1955: Was wrongly diagnosed and treated for TB by Dr Moses TB specialist in Chennai India with sulpha injections for nine months. Re diagnosed as Whooping cough by another doctor and cured in two weeks. This caused inguinal hernia at age 9.


1976 : Tinnitus diagnosed in right ear at hearing test . Ringing continues and wear hearing aid when in noisy surroundings like restaurants or watching movies. OK with one on one conversations.


1980: Constant blocked nose. Addicted to Otrivin nasal drops. Septum deviation Surgery aborted by Dr Bridger at POW as I could not be intubated for surgery. Small jaw and narrow airways I was told. Almost died in the theatre at POW. Was told to wear a medical bracelet


1982: Rhino Plasty done at St.George by Dr Williams. Intubation posed severe problems and required three anaesthetists on duty to knock me out and keep me breathing


1986: Surgery for inguinal Hernia performed at POW


1989: Diagnosed with Hypertension and have been on medication since. Now take Avapro 150mg daily


1990: Diagnosed with Severe Sleep Apnea and wear CPAP mask since. ( Dr Sullivans Patient) Use Resmed S9 with humidifier & full face Fisher and Paykle Simplus Mask. Current pressure setting (2014) is 15 to 20cms H2O and 95% of the time pressure reqd is 19cms with apnea index of 1.7


1992: My skin reacts to ultraviolet light and I get severe itchy skin on nose ears neck and hands. So I was told to avoid the sun and wear full sleeves


1998: Severe Reflux: Gastroscopy done by Dr. Christopher Low with a lot of difficulty due to intubation problems to reveal Hiatus hernia and Oesophagal ulcers. Taking Losec since


2000: April 13th: suffered a massive brain stem stroke, lateral medullary infarct or Wallenberg syndrome with Horners syndrome caused by dissection / occlusion of the right vertebral artery upto the mouth of the Right PICA. Suffered post stroke TIA’s caused by Hypoperfusion of the Right Pica for many years to follow. This vertebral artery is now completely blocked. My left leg was paralysed and I lost control of my right hand and the right side of my face was affected, lost balance and had incontinence, slurred speech and could not swallow and had double vision with drooping eye lids. I have consulted over 20 neurologists / neuro surgeons world wide to stay alive.


July 2000 Diagnosed with Thrombocytosis after Bone marrow test by Dr Harry Illand at RPAH and treated with Hydroxyurea 1500 mg a day. Platelet count when I had the stroke in April 2000 was 890. Abandoned treatment due to drug reaction in 2003 – ulcer in ankle that would not heal. Platelet count hovers around 450 to 550 now in 2014.


August 2000: Cerebral Angio was done in Aug 2000 at POW Private by Dr. Stoodley. PICA Bypass was proposed but declined considering risks. Been on Warfarin 7 to 10 mg and Plavix 75mg since. Was asked to keep my BP marginally higher at 140/85 to ensure blood flow to Pica region and to keep my INR at about 2.0 to 2.5 Max












Image of Missing right vertebral artery


2002: went to UK to consult neurologists about my Post stroke TIAS.


May 2002: Underwent a Uvulo Plasty Laser surgery in London to stop snoring. Offered great relief for three years. All the soft tissues have grown back with a vengeance now and I am snoring even with the sleep apnea mask




2002: Diagnosed with Fibromyalgia – Chronic Pain and Fatigue. Was on Seroquel & Oxycontin for three years


2003: Prolapsed Lumbar disk L5-L6. Surgery considered by Dr Steele at Concord Hospital but not done as too risky with me on warfarin & Plavix.


2004: Diagnosed as Type 2 Diabetic and treated with diabex. In 2007 was put on insulin by encocrinologist Dr. Arnold. Lantus 40 units at night gave me a strange reaction. It felt like an electric current passing through my body all day. Novorapid with meals to suit. Now on Diabex 1000mg x 2 a day plus Novo Rapid as and when required. HBA1c around 7.5 to 8,5. 5units of Novo rapid gave me a massive hypo when I used it first time in 2007. Now in 2014 even 30 units does not budge my BSL in a hurry. I have developed severe insulin resistance


2007: Severe constipation and bloated stomach. Gastroscopy and colonoscopy done by Dr Warwick Selby and declared all was ok.


2008: Abdominal Pain, Bloating and constipation continues. Gastroscopy done by Dr Samarasinghe and diagnosed as Lactose intolerance. Off all Milk products and use Lactose free Zymil Milk now.


2009 Infected by Dengue Virus in India and platelet count plummeted from 550 to 280 over night. Fortunate blood transfusion was not required. Have suffered from severe joint pains since, especially knee and fingers


2009: Ultrasound found 6mm Floating Galstone


2010- Suffering from severe shortness of breath and chronic fatigue. Cardiologist Dr Chung conducted and Echo Cardiogram and stress test. After 7-1/2 minutes because of extreme shortness of breath and wheezing and gasping for breath, he concluded the heart was fine and that I had exercise induced asthma.


So my GP Dr. Weinman put me on Ventolin and now Simbicort. These have not helped and I am still very short of breath especially climbing staircases or even mild exertion. My lung capacity is just 400cc


CT scan of the lungs was done and lungs declared clear but calcification of coronary artery reported, Hence CT angio was done at my own expense and coronary artery cleared.


CT scan also shows enlarged Adrenal gland on the left side
I have had allergy tests done and all found to be negative.


2010- Dr Vander Porten did a gasteroscopy and I stopped breathing during the procedure. Delayed gastric emptying and severe Gasteroparesis was established by Dr Vander Hooten .I stopped breathing during the procedure and my blood oxygen saturation level dropped to 40% and anaesthetist told me never to accept such procedures again.


2010 to 2014: Extremely short of breath even climbing one flight of stairs or walking up the ramp at railway station. Have consulted Dr Alwyn Ing, Respiratory & sleep apnea specialist who has performed lung functions test and cleared the lungs. He believes I have metabolic syndrome but I did not qualify for the metabolic clinic at Concord Hospital as I am only 93 kilos in weight.


Current Findings:
A small 2mm stone in left kidney
Enlarged left adrenal gland
A floating 7mm gallstone
Fatty Liver
Slightly enlarged spleen
low in Vitamin D
Low on Vit B 12
Low in Iron
INR between 1.8 & 2.5
Platelet count 460
RBC 6.0
MCV 68
WCC 15.7
Monocytes 2.5
HbA1c between 7.3 and 8.5


Current problems:


Severe sleep apnea
Fasting sugars above 8.0 despite all efforts and medications ( now only Diabex 1000mg x 2) and insulin on occasions as suggested by Endo.
Chronic Pain requiring pain killers
Chronic Bloating and Constipation ( need 6 Ducolax tablets to move the Bowels)
Enlarged spleen
7mm Gal stone
Enlarged adrenal gland
Fatty Liver
Sciatica
Low on Vit D, Iron and B12
Gastric emptying studies showed stomach does not empty even after 4 ½ hours suggesting gasteroparesis




Current Symptoms:
Very disturbed sleep every night.
Waking up feeling dead despite using cpap mask.
High fasting BSL above 8.0 even if I skipped dinner at night; Hba1c now is 7.6
Extremely short of breath
Pain at the bottom of sternum and under rib cage on left.
Pain and discomfort from Bloated abdomen
Dull and constant pain on right side of abdomen
Chronic constipation
Chronic Pain & Sciatica causing left leg and toes to go numb


Current medications:
Morning 8.30am - 1000mg Diabex, 150mg Avapro, 75mg Plavix
Evening 6.30pm - 10mg Warfarin, 1000mg Diabex
Take Panadene forte when chronic pain gets worse but not regularly as it causes constipation


Take 5 Ducolax tablets at night ( once a week ) to move bowels 18 hours later ( that is how long it takes)




Need help to understand what causes bloating, delayed stomach emptying, gasteroparesis and constipation without gasteroscopy to avoid anaesthesia and intubation that has almost killed me three times now in the theatres

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Report of CT Abdomen done on 21st May 2014 requested by Dr.Weinman , mentions a 7mm mobile Calculus in Gal bladder with the bile duct dialated to 4mm, pancreas define normally, minor arethroma of aorta, liver shows fatty infiltration, a small echogenic foci in relation to left kidney in relation to the cortex probably represent focal acoustic enhance ment related to microcytes. No hydronephrosis or definite calculus disease. Spleen shows border line enlargement. No abdominal masses or other fluid or other findings on note. Spleen in particular shows borderline enhancement.