Aaron-Progressive myodystrophy-(Malaysia)

Name: Aaron See Cai Jun                   
Sex: Male
Country: Malaysia
Age: 21
Diagnosis: Progressive myodystrophy
Admission Date: November 16, 2012

Before treatment:
12 years ago (at the age of 9), Patient suffered from squatting difficulties with no obvious reason. Aaron did not take care of it. Then the patient found that the strength of his lower limbs gradually declined. Without the assistance of both hands, he couldn't stand up from the squat position. He didn't receive treatment. 6 years ago, the patient found the muscle strength of his lower limbs was gradually reduced. He had difficulty with climbing stairs. He needed the assistance of stair rail  to climb stairs 5 years ago. He went to the local hospital and was diagnosed with muscular dystrophy. Then he received rehabilitation exercises and took health care products for treatment. The disease progressed gradually. At present, the patient walks slowly. The walking gait and posture was almost normal. The exercise endurance was poor. He was easy fatigue and easy to fall down. He had difficulty with get up and sitting up from supine position. This action needed the assistance of both hands. He couldn't go upstairs or run. He tends to walk on tiptoe. The muscle strength of both upper limbs was reduced.

Nervous System Examination:

Aaron was alert, and he was in good spirits. His speech was clear. His memory, calculation abilities and orientation were all normal. Both pupils were equal in size and round. Both eyeballs could move freely and flexibly and the pupils were sensitive to light stimulus. The forehead wrinkle pattern was symmetrical. The eye closing ability was strong. The tongue was centered in the oral cavity and the teeth were shown without deflection. The soft palate could be raised strongly. The swallowing ability was normal. The neck was soft. There was obvious muscle atrophy in shoulder girdle, bilateral triceps muscle of arm and quadriceps femoris. Bilateral gastrocnemius had pseudohypertrophy. Both lower limbs were not symmetrical and the right limb was larger than the left one. He had strong muscle to swivel and shrug shoulders. The adduction strength of both upper limbs and bucking muscle strength of elbows was level 4. The push forward muscle strength of both arms was level 3, other upper limbs' muscle strength was level 4+. The muscle strength of the left lower limb to stretch knee was level 4. And the muscle strength of the right lower limb to stretch knee was level 4+. The muscle strength of both the lower limbs to bend knees, adduction and abduction was level 4. The muscle strength to bend hip and stretch hip was level 3. The right lower limb was better than the left lower limb. Other lower limbs muscle strength was level 5. Both lower limbs couldn't lift off the bed surface. He could turn over autonomously. And the turn over action was clumsy. The abdominal muscle was weak. He had difficulty with getting up from the lying position. He also had difficulty with standing up from the sitting position or the squatting position. The action needed the assistance of both hands. The Gower's sign was positive. He could walk independently. The walking posture and gait was almost normal. The walking endurance was poor and he tired easily. He had difficulty with climbing stairs. The muscle tone of both upper limbs was almost normal. The muscle tone of both lower limbs was low. The tendon reflex of both upper limbs was low. The patellar tendon reflex of both lower limbs was not elicited. The Achilles tendon reflex was normal. The abdominal reflex was normal. Bilateral pathological reflex was negative. Bilateral deep and shallow sensations were normal. The patient could finish the finger-nose-test, digital opposition test and rapid rotation test almost normally. He had difficulty with the heel-knee-shin test. He had poor control ability with balance control. There were no signs of meningeal irritation.

Treatment:

We initially gave Aaron See Cai Jun a complete examination. The patient received treatment for neural repair and neural regeneration. The patient also received treatment to nourish the nerves, protect liver function, reduce creatine phosphokinase and improve blood supply. This was accompanied with daily physical rehabilitation treatment.

Post-treatment:

The patient's condition is better than before. The motor ability and endurance are improved. The muscle strength of four limbs has improved. The abduction strength of left upper limb is level 5-. The push forward muscle strength of both arms is level 4-, others muscle strength of upper limbs is level 5. The muscle strength of extension of the left knee joint is level 4, the muscle strength of extension of the right knee joint is level 5. The abduction muscle strength of both lower limbs is level 5. The muscle strength of bend his knees was level 4+. The adduction muscle strength of both lower limbs is level 4+. The muscle strength of bend left lower hip and stretch left lower hip is level 4. The muscle strength of bend right lower hip and stretch right lower hip is level 4+. Other limbs muscle strength is level 5. The patient can straighten right leg when blocking up right popliteal fossa 30cm. And the left leg can lift from the bed surface about 5cm when the block up left popliteal fossa 30cm. Other lower limbs' muscle strength is level 5. The muscle tone of both lower limbs is normal. Left biceps reflex is elicited normally.

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2012-12-30

Greetings Dr Xinrui Xi (Wu Medical Center),

This is my first email updating on my condition after receiving treatment from your institution. I rested for the first week, and started with Physical and Occupational Therapy in the second week. Following Dr. Wu's advice at my discharge meeting, i am spending 1-2 hours a week on PT and OT exercises. I have been taking all the prescribed medicine accordingly. The only exception is Folic Acid which was prescribed by you to be taken at 0.4mg. However only 5mg is available to us, as such we cut the tablets into 1/8 its size to reduce the dosage. Is this acceptable?

My physical condition appears to be stable, as per my discharge state. I do not feel weaker, however whether due to the treatment or a placebo effect, I do feel slightly stronger in the shoulder, back, arm and waist muscle regions. The shaking in my hand and fingers persists, and I feel very minor twitching in all parts of my body when i remain motionless. The dreams when i sleep persists as well, however i do not wake up in sweat anymore.
Appetite and rest routines are normal.

Thats all for this report. Kindly advise or feel free to ask questions. The next report will be in two weeks, with my blood test results. Thank you, and Happy New Year to all the staff.

P.s. Mr. Grisha requested for all of my emails to be sent to him as well, but we do not have his email address. Kindly forward this email to him. Thank you. 

Regards, Aaron