Dr Brian Cluney
Stuart Park Surgery, 1/5 Westralia St Stuart Park.
I am the older brother of William [Bill] and live in Shepparton, Victoria, semi retired GP. Bill lives with his partner Janine in an upstairs house at Tong Luck St, Rapid Creek and attends your practice. He has been having a lot of difficulty with back and leg pain in the last 6 months which has been causing a lot of concern to him and to his 92 year old mother, Nancy, who currently lives in the Gold Coast but had been a Darwin resident for 55 years.
Bill has had 3 major accidents in his life. At 17 yo in Adelaide he was hit by a car and thrown onto the windscreen. Not sure if knocked out or severity of other injuries.
His major accident was in 1982 when his father rolled a Ute on the way to Broome, WA throwing Bill out. He was flown to Royal Perth Hospital deeply unconscious and remained in a coma for 6 weeks with head injuries. He slowly recovered but had severe right sided weakness of his arm and leg needing prolonged rehabilitation. He was also left with permanent double vision. The main problem however was altered personality [? frontal lobe] and a marked decrease in mental cognition.
After several years he returned to work as a wharfie with his father on the Darwin Wharf , and also as a health and safety officer. Some years after that ??1987 he had his third accident when he fell 22 feet down a ship’s hold. The result of this was severe bilateral torn rotator cuffs which put an end to his wharf career and caused him to be in severe pain for quite a few years. He did see surgeons at Darwin Hospital, not sure of he had operations.
He tried to work spasmodically since then but has basically been unemployed reliant on a pension set up by his mother from his motor car accident .
Bill is very hard to get history out of because of his poor memory. He tends to make light of his problems due to a combination of poor memory and possibly a frontal lobe injury affect. He is difficult to treat because he forgets instructions and lacks motivation. Worse he has a strong belief in alternative and unusual medicine and is immune to reason.
Despite this he has an easygoing personality and is always willing to help out others. I have left him to his own devices in the past as his mother and sister, Jennifer Lee, had mainly been involved with his supervision.
The problem currently is repeated attacks of severe leg and back pain which make it very difficult to get up and down the stairs at home for the last 6 months. I saw the CT back you arranged which showed the L5 disc protrusion and nerve root possible compression and the funny little comment re bubbles in the L3/4 canal.
He went to the Darwin Hospital Casualty last night [Sunday] with right upper inner leg pain down to the knee. The doctor on call tried to get him admitted but there were no neurological symptoms and the consultant opted for referral to physio at the Hospital and a non urgent Orthopaedic review which could take months. He suggested that I contact you to ask if you could also refer him to the Orthopaedic unit as this might help speed assessment up.
Also a care plan for physiotherapy if it is helping.
I realise the problems inherent in managing back pain, it is Australia wide. Bill is 8 years younger and Dad had both prostatomegaly and bowel cancer late in life. Bill is only 57. Bill does not normally complain of pain and incapacity without reason and it is a worry that this has been going so long. There may be some arthritis from his accidents, there may be a disc compression problem if he has neurological symptoms and the doctor at Darwin Hospital did say something about some narrowing of the right hip joint.
I wondered if a PSA and a bone scan might help rule out any other causes if his back pain continues and you feel they are worth doing. I hope to get up to Darwin in May to assess his situation and hope we can speak then.