1.1 Prior Medical History

1.1.1

Prior to traveling to Japan, for his 5th time, in May 1999 Wayne was fit healthy and well (refer Dr. Barry ter Haar letter dated 19/10/06).

1.2 Patient Profile

1.2.1

When Wayne presented to our service, with the exception of Wayne’s use of Cannabis (as noted in point 1.2.3), use of Nicotine and alcohol (as noted in point 1.2.4) the only history of note with Wayne regarding substance use was the Benzodiazepine regime that he was initially prescribed by Dr. X in 2000.

1.2.2

On detailed questioning by both me and the Detox Nurse, who interviewed Wayne, he had no prior history of hallucinogen use, no history of opiate use, no history of solvent use, no history of stimulant use and had abstained from alcohol since May 2000.

1.2.3

Wayne does acknowledge that he used cannabis between ages of 15 and 21 but has had no cannabis since the age of 21. Wayne reported that he smoked about 1 marijuana cigarette between about 5 people at parties.

1.2.4

Other history included smoking cigarettes, as a minor, and the occasional drinking of alcohol. Wayne reported that he “played with cigarettes a couple of times” as a nine year old without actually inhaling anything. Then he smoked regularly between the ages of 14 and 17, but only about 5 per day. He has not smoked at all since then. Regarding alcohol, Wayne reports that he drank about 4 (less than six standard drinks) glasses of beer occasionally on a social basis at parties. This pattern of alcohol use is well within the recommended safe New Zealand drinking guidelines of no more than 6 standard drinks on any one occasion and no more than 21 standard drinks per week.

1.2.5

Wayne’s history did not suggest that he had an addictive personality.

1.2.6

This is further evident in the fact that Wayne was particularly keen to withdraw from his Benzodiazepine regime upon learning of their addictive nature and the fact that they were likely contributing to some of his underlying symptoms at the time.

1.2.7

Furthermore, Wayne made 3 attempts, although unsuccessful, to reduce his drug intake during the course of the drug treatment that he was being prescribed (1st attempt at end November 2000, 2nd attempt at beginning of March 2001, 3rd attempt at end of March 2001).

1.3 Substance / Prescription History

NB: The substance use history between 5th July 2000 and 9th April 2001 is based on information provided to me by Wayne and his lawyer, Mr. A.

Below is a breakdown for the Benzodiazepine component of the prescriptions.

NB: The prescriptions between 9th April 2001 and 5th May 2001 were all prescribed by Dr. Whitwell. My role was to help Wayne with the reduction process.

On top of the Benzodiazepines (Chlordiazepoxide, Clonazepam, and Tofisopam) outlined above, Wayne was also prescribed the following drugs by Dr. X.

NB: I have been informed that the Benzodiazepines (Chlordiazepoxide, Clonazepam, and Tofisopam) prescribed by Dr. X were all mixed together in a powder form contained in sachets. The Imipramine was in tablet form and the Ibudilist was in capsule form. The dosages never changed.

1.4 History of Symptoms

NB: the details under 1.4 are based and copied from details provided to me in written form by Wayne.

Pre-Drug Treatment Symptoms

1.4.1

Wayne informs me that he experienced the below symptoms whilst working at a stressful job in Shizuoka. I can confirm that these symptoms are consistent with stress.

Around October 1999

1. Sweaty palms
2. Shortness of breath.
3. Racing / scattered thoughts
4. Sleep disturbances
5. Pressure in temple areas
6. Swelling of temporal veins
7. Fatigue / lethargy

1.4.2

Wayne reports that most of the above subsequently disappeared after changing jobs at the end of March 2000.

1.4.3

Wayne reported the below symptoms following an acute vertigo attack.

11th May 2000

1. A single attack of rotational vertigo
2. Vomiting / Nausea
3. Flushes
4. Initially unable to stand
5. Difficulty walking for a week thereafter
6. Ongoing unsteadiness
7. Subsequent anxiety over not knowing what was wrong

NB: I understand there are differing views as to what exactly caused the above symptoms.

1.4.4

Upon initial presentation, Wayne handed Dr. X a list of symptoms associated with his vertigo attack; including those above (1.4.3). As an additional part of this list Wayne wrote the following general history under the title “Other”.

“Early 1998 ~

1. Stiffness in shoulders

NB: following this I (Wayne) began the habit of clicking my (his) neck

April 1999 ~  

1. Bad tooth (currently receiving treatment)

NB: Since late May, the toothache has caused inflammation in my (Wayne’s) cheek, eye pain and swelling of glands

June 1999 ~  

1. Became a bit lethargic

NB: Have been feeling lethargic since coming to Japan (due to difference in environment)

Early 2000 ~  

1. Shortness of breath
2. Pain in the temple areas and swelling of the surrounding veins (these symptoms disappeared following dental treatment)

Late April ~ 11 May 2000 (time of vertigo attack)

1. Very lethargic
2. Fatigue
3. Eyes feel like they are swimming around

Post-Drug Treatment Symptoms

1.4.5

Following about 2 weeks of Dr. X’s drug treatment Wayne reports that he noticed some initial settling of symptoms as below.

Mid ~ End July 2000

1. Settling in dizziness
2. Settling in anxiety levels

1.4.6

Following about 1.5 months of Dr. X’s drug treatment Wayne reported that he had; continuing symptoms, worsening symptoms and some new symptoms as well. Wayne made regular complaints of his new symptoms, both in written and verbal forms.

Mid ~ End August 2000

Continuing symptoms included (in Wayne’s words)

1. Continuing staggering (especially feel queasy when washing dishes, taking shower)
2. Lethargy and fatigue (still the same)
3. Shortness of breath (little improvement)
4. Eyes feeling like they’re swimming around (now, only at mornings)
5. Legs feeling weak (they momentarily came right, but now can’t seem to get much strength into them)
6. Feeling woozy
7. Summer lethargy
8. Stress & fatigue
9. Stiff shoulders

Symptoms that worsened included

1. Dizziness
2. Feelings of anxiety
3. Worsening levels of fatigue
4. (Worsening of hemorrhoids)

New symptoms included

1. Palpitations / Heart pounding
2. Loss in appetite
3. Mouth ulcers
4. Chronic Thirstiness
5. Reoccurring nausea

1.4.7

Following about 4 ~ 6 months of drug treatment Wayne states that his condition continued to deteriorate and that he developed several more new symptoms as below.

Between October and December 2000 (in Wayne’s words)

Additional new symptoms included

1. Tinnitus - from November, started to experience light tinnitus (when trying to sleep and upon wakening)
2. Vitreous opacities - Developed what appears to be a smear on the lens of eyes (In right eye, can be seen even after eye is closed) From October
3. Became sensitive to heat (body temperature seems to change all the time)
4. Pulse rate is higher than usual
5. Flushes
6. Loss in sexual interest
7. Developed habit of always closing eyes
8. Starting to feel detached
9. Pressure in chest
10. Occasional stomach pains
11. Loss in appetite / Anorexia
12. Jaw stiffness and pain
13. Painful & stiff joints, muscles felt tight, heavy and numbed
14. Lost more than 10 kilos in weight
15. Inside of head twitches and pulsates
16. Tightness across forehead and scalp
17. Physical weakness
18. Paresthesias
19. Visual disturbances
20. Increased sleep disturbances
21. Slightly effected speech
22. Hypersensitivity
23. Sensitivity to sound and light
24. Emotional Instability (including panic attacks, anxiety, depression, mood swings, aggression)

NB: Wayne also noticed at this stage that he was now suffering from feelings of emotional instability and panic attack-like episodes - something he had not experienced before. Apparently Wayne continued to complain of these new symptoms in both written and verbal forms.

1.4.8

I have been informed that Wayne changed to the O Medical Center, where he listed the following symptoms in his Patient Questionnaire Form.

21st January 2001

1. Dizziness
2. Staggering
3. Shortness of breath
4. Lethargy
5. Fatigue
6. Jelly leg sensation
7. Muscular pain/stiffness in neck and back
8. Nausea (periodic)
9. Sparkling sensation in vision
10. Appears to be marks on eye lenses
11. Head seems to pulsate more than usual (especially when sleeping)
12. Sensation of head rushes
13. Deterioration in sense of balance
14. Shoulder stiffness
15. Pressure in sinus
16. Have become prone to mouth ulcers
17. Hemorrhoids
18. Palm of hands sweat abnormally