SINGAPORE – A 51-year-old woman who recovered from a brain tumor died after consuming traditional Chinese medicine (TCM) that probably caused her acute liver failure, the state coroner found.
The cause of Shirley Seah’s death was certified as massive liver necrosis, and a forensic doctor said clinicians concluded that Seah had suffered a drug-induced liver injury, probably due to the use of TCM.
While it was unclear how TCM herbs had caused Seah’s liver failure, state forensic expert Kamala Ponnampalam classified his death on August 2, 2019 as an unfortunate medical mishap, according to available findings. on Monday (May 31).
SC Ponnampalam said conflicting accounts between witnesses raised the possibility that Seah had consumed an incorrect dose of TCM drugs.
Seah had undergone emergency surgery on June 15, 2018 to remove a brain tumor, which was later found to be cancerous. The following month, Seah sought treatment for cancer from a registered TCM doctor. He consumed both Western and TCM medications from July 2018. He continued the prescription until June 25, 2019.
He also started a course in combination chemotherapy and radiation therapy, followed by six cycles of chemotherapy at the Singapore National Cancer Center (NCCS) from August 2018 to March 2019.
The medical report prepared by a senior NCCS consultant indicated that Seah had not informed him of TCM consumption during his consultation with him. His liver function, which was regularly monitored during consultations at NCCS, was normal. NCCS prescribed Seah medications during the period.
In May 2019, an MRI of his done brain showed no recurrence of the tumor.
In July 2019, Seah developed jaundice and was admitted to Khoo Teck Puat Hospital. She was subsequently referred to the National University Hospital for liver transplant surgery, but was deemed unsuitable for surgery. His liver function continued to deteriorate until he died on August 2, 2019.
The TCM doctor stated that he had prescribed soft herbs to Seah and told him how to prepare them and when to consume them. He told her to take herbs and Western medicine four hours apart. It looks like Seah followed the instructions.
However, Seah’s aunt, who was his janitor, gave a conflicting account. The aunt said Seah had been advised by the doctor to drop the prescription a week before her radiation and chemotherapy sessions and Seah had complied.
“These conflicting accounts raise the question of what regimen Mrs. Seah had followed. If there was some confusion about the dose during cancer treatment, it raises the possibility that the confusion would persist even after her therapy at (NCCS). , which would lead to possible mismanagement of herbs or involuntary overdose, ”SC Ponnampalam said.
An expert from the Chinese Academy of Medicine had stated that the herbs prescribed in Seah were commonly used in the clinical practice of TCM in Singapore.
“The prescription dose was adequate and therefore unlikely to affect liver function if the difference between Western drug intake and TCM medication was separated by several hours,” according to SC Ponnampalam.
The SC said, “It is always important to clearly explain to patients the dose and use of medications and dispensed medications. This also applies to those in the practice of TCM.”
He added that patients who had recently recovered from an illness should be monitored more closely with proper consultation to confirm compliance with prescriptions and for patients to disclose other medications to avoid complications.
According to SC Ponnampalam, hospitals should consider applying a compelling protocol for the disclosure of alternative medical treatments so that the patient can be adequately counseled to avoid unfortunate outcomes.
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