Have you ever had your parents tell you not to take Chinese and Western medicine at the same time?
You might have listened to them, but probably never understood why. Or you might have simply brushed them off—if so, you should probably think again.
You might be asking, what’s the worse that could possibly happen?
51YO’s Woman Death Possibly Due to Confusion Over TCM and Western Treatments
In August 2019, 51-year-old Madam Shirley Seah died soon after doctors found that she had symptoms suggestive of early impending acute liver failure.
Mdm Seah had been diagnosed with cancer in June 2018. Between August 2018 and March 2019, she underwent chemotherapy and radiotherapy for a brain tumour. During that time, she has also consulted a Traditional Chinese Medicine (TCM) physician to complement her other treatments.
According to State Coroner Kamala Ponnampalam, Mdm Seah might have been confused with the instructions on when to take her TCM medication. This might have resulted in the possible wrong administration of herbs or inadvertent overdosing.
The TCM physician who Mdm Seah had consulted, Mr Ong Liang Seng, had told her not to consumer both Western and TCM medicine at the same time. The instructions given to Mdm Seah were to only consume each packet of herbs once a day, and about 12 hours apart.
Mr Ong, who retired in 2019, had also instructed Mdm Seah to maintain a four-hour interval between consuming western medicine and TCM herbs.
However, in the accounts of Mr Ong and Mdm Seah’s aunt, who was caring for her, there were conflicting details of the regime that Mdm Seah had followed.
Mdm Annie Lim Sai Luang, who was the aunt of Mdm Seah, said that the TCM physician had advised Mdm Seah to stop her TCM prescriptions one week prior to her scheduled chemo and radiation therapy sessions.
On Monday (31 May), Ms Ponnampalam’s findings were released. In her findings, Ms Ponnampalam stated that “If there was some confusion about the dosage during the cancer treatment, it raises the possibility that the confusion persisted even after her therapy at the National Cancer Centre Singapore (NCCS), resulting in possible wrong administration of the herbs or inadvertent overdosing”.
Referring to Mdm Seah’s death as an “unfortunate medical misadventure”, Ms Ponnampalam emphasised the importance for medical practitioners to explain clearly to patients the dosage and usage of drugs and medications prescribed—even those in TCM practice.
Noting that is is common for cancer patients to seek both TCM and Western treatment concurrently, she suggested that hospitals consider implementing a system where patients had to disclose any alternative treatments they were seeking.
With such a protocol, patients can be given proper advise on how to avoid unfortunate outcomes such as in Mdm Seah’s case, said Ms Ponnampalam.
Deterioration of Mdm Seah’s Condition
On 15 June 2018, Mdm Seah first discovered that she had cancer after going for an emergency operation to remove a tumour in her brain.
Afterwards, she started both chemo and radiation therapy, which was followed by six cycles of chemotherapy at the National Cancer Centre Singapore (NCCS), located at the Singapore General Hospital campus.
The treatment was completed in March 2019, and a magnetic resonance imaging of her brain had indicated that she had successfully recovered from the brain tumour.
However, a few months later on 10 July, she was admitted Khoo Teck Puat Hospital (KTPH) after experiencing jaundice, nausea, vomiting and abdominal discomfort.
Doctors discovered that her liver function had already become “severely deranged”, with symptoms suggestive of early impending acute liver failure.
It was then that Mdm Seah revealed that she had consumed TCM medicine for four months before the flare-up, after which doctors got her started on an antidote meant to treat drug-induced liver injury from TCM medication.
On 2 August 2019, Mdm Seah died at National University Hospital (NUH). Doctors at NUH had deemed her an unsuitable candidate for a liver transplant due to her brain tumour history.
According to forensic pathologist Dr Paul Chui, who performed Mdm Seah’s autopsy, it is not possible to establish a definitive link on whether the TCM medication had caused her death. Though, circumstantial and clinical suspicion did point to that, said Dr Chui.
TCM Prescription Dosage Appropriate
Mdm Seah had started consulting Mr Ong on 14 July 2018, just two days after her discharge from the hospital after the emergency surgery to remove the brain tumour.
From then, she went for a total of 18 follow-up consultations at the TCM clinic. Even after NCCS stopped prescribing her medication after the end of her final cycle of cancer treatment on 19 March 2019, Mdm Seah continued taking the TCM prescriptions.
Her last consultation was on 25 June 2019, not long before she was admitted to KTPH with a failing liver.
Between 19 March and 25 June 2019, she had gotten TCM herbs six more times. Of the six times, thrice had been done without consultation with the TCM physician—instead, Mdm Seah had gotten the herbs when accompanying her mother to the clinic.
According to Mr Ong, the herbs prescribed were “very mild”, and Mdm Seah did not appear to have developed any side effects from taking them. Mr Ong also told the court that Mdm Seah had told him that she had complied with his instructions, and was taking the TCM and Western medicine four hours apart.
Second Vice President of the Academy of Chinese Medicine, Mr Sng Kia Hock, reviewed the TCM herbs that had been prescribed by Mr Ong during the course of the coroner’s inquiry. He said that the herbs were those routinely used in clinical TCM practices in Singapore.
He also concluded that the prescription and dosage were both appropriate, saying that they were therefore unlikely to have affected liver function. Mr Sng added that there should not have been any problems as long as there was a gap of several hours between the intake of the TCM and Western medicine.
Though Ms Ponnampalam wrote in her findings that confusion could have contributed to Mdm Seah’s death, she also reiterated that it remained unclear how the TCM herbs had caused liver failure. She had also ruled that the TCM prescription dosage was appropriate.
Feature Image: Dragon Images / Shutterstock.com
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