Dutch doc: Anwar still suffers from back pain

Prime Minister Najib Abdul Razak and Rosmah Mansor need not testify in the sodomy trial after the Kuala Lumpur High Court today allowed their applications to set aside the subpoenas issued for them to take the witness stand.

Najib and Rosmah's lawyers had claimed that they were not relevant and material witnesses for Anwar's defence.

Their applications were supported by the prosecution.

Lead defence counsel Karpal Singh, however, had argued that Najib could tell the complainant Mohd Saiful Bukhari Azlan's state of mind when they met - two days before the alleged sodomy incident at the then deputy premier's Taman Duta home in June 2008.

After justice Mohamad Zabidin Mohd Diah delivered his decision, the court proceeded with its hearing of the Anwar Ibrahim's trial.

Dutch spine specialist Dr Thomas Hoogland who had performed surgery on Anwar's back in 2004 was called to take the witness stand.


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8.50am: Lawyers for Najib, Rosmah arrive: Ghazi Ishak, Hisyam Teh Poh Teik, Salehuddin Saidin and M Athimulan.

The prosecuting team are also in court.

A white computer screen has been set up.

8.55am:  Queen's counsel Mark Trowell walks in. He is an observer from the Inter-Parliamentary Union.

Among the diplomatic corp present today are officials from the US and German embassies.

9am: Saiful's lawyer Zamri Idrus walks in.

9.05am: Anwar arrives with PKR president Dr Wan Azizah Wan Ismail and a number of supporters. Also present is his lawyer Param Cumaraswamy.

9.09am: Lembah Pantai MP Nurul Izzah Anwar walks in.

9.37am: Court starts with Justice Zabidin presiding.

He begins to deliver the decision.

After hearing and reading the affidavits, the court agrees to allow Najib and Rosmah's application.

9.41am: Dr Thomas Hoogland takes the stand. He is an orthapaedic surgeon, aged 66. He lives in Munich, Germany.

N Sankara is questioning.

"I am here to give evidence as Mr Anwar's doctor," Hoogland says.

9.44am: Hoogland states his credentials, his academic qualification and that he has a Phd from the Birmingham University.

9.46am: The doctor says he has performed 14,000 spine surgeries.

He has written five books on spine surgery. He is a member of the German Society of Orthapaedics and his main interests is orthoscopic surgery.

10.04am: Hoogland explains the lumbar part of the spine and its functions.

He explains that a slipped disc is excruciating pain to the back. It can cause a lot of problems, particularly when standing.

10.08am: Hoogland uses computer images put up on a white screen to explain from the witness stand.
He explains that a stenosis is a narrowing of the canal in the spine.

10.17am: Hoogland (left) says he met Anwar in April, 2001, while he was in prison under police surveillance.

He saw him again in September 2004 after Anwar was released.

"Anwar arrived at the Alpha Clinic in Munich, Germany. It was clear and decided then that he undergo surgery."

"He had surgery with local anaesthesia."

10.19am: The witness says he prepared his report on the Anwar surgery and gave Anwar a copy of the report upon the politician's request.

10.21am: He says Anwar has lumbar sclerosis, which affects the patients leg and hand.

"In particular, the left leg, following an old neck problem."

He said when he met Anwar on Sept 4, 2004, Anwar had complained then of being assaulted while in police custody six years earlier.

10.24am: The witness says that the longer the nerve is irritated, the more likely it would result in subsequent loss of function.

10.30am: Anwar has problems bending forward and which limits the mobility of his spine.

10.36am: He says Anwar was in the hospital for three weeks, from Sept 6 until Sept 27, 2004.

"There was no complication."

10.43am: Anwar has, however, pain on the left side.

10.43am: Hoogland is asked whether the problem would recur, to which he replies the recurrence rate is 5 to 20 percent.

"As to sclerosis, it is 15 percent."

10.47am: Hoogland says degeneration of the bones is not a natural process, but it is quite normal.

10.50am: Hoogland's medical report is marked as evidence. Hoogland explains the surgery performed on Anwar on Sept 6, 2004.

10.55am: Johor PKR chief Chua Jui Meng walks into the courtroom.

10.56am: Hoogland's surgery report is marked as evidence.

11am: Hoogland says Anwar's fourth and fifth lumbar disc has healed, unlike before in 2001.

11.02am: Sankara asks for a short break, to which the judge allows.

11.45am: Court resumes.


11.46am: Machang MP and PKR secretary-general Saifuddin Nasution Ismail enters the courtroom.

Hoogland says three months after the surgery, Anwar went again to his Munich clinic in February 2005.

The witness says on Feb 7 that year, he did an examination and it indicated that Anwar continued to suffer from back pain every now and then.

11.50am: He says there was significant improvement in Anwar's condition before the surgery, but there was not much change after he was discharged from the hospital on Sept 24, 2004.

"The back muscle is important to control the back movement."

11.54am: Hoogland says he has treated many Muslim patients from Middle Eastern countries, and praying is always an issue.

"I advised Anwar that when performing prayer, to do it carefully and slowly.

"You can bend forward quickly but when you go back, do it very slowly (moving back upright and standing)."

11.58am: Hoogland says he advised Anwar to rise up slowly as it could cause severe pain and injury to the disc.

"When you move too quick, it would result in more rubbing and result in more athritis.
"Anwar has severe athritis."

12.01pm: Hoogland says he last inspected Anwar on Sept 8, 2011, and he found that the politician suffering from both athritis and stenosis.

12.03pm: The spine doctor says that Anwar has limitation in the mobility of his back, and experienced numbness on the left side and one of his legs.

12.05pm: There was significant pain on the left side and left leg.

"After surgery in 2004, the straight recreation test was negative, however now it is positive."

"Tests that I did, there is evidence of compression on the left side. Reflexes were normal."

The witness says Anwar has weakness on his left foot. There is weakness in both strength and sensation.

12.10pm: He says there is some limitation to Anwar's back movement as it is confined to 10 degrees.

"We can bend 90 degrees - no problem, but when bending 15 degrees or 10 degrees, he will have a pain."

12.16pm: Hoogland testifies that Anwar has significant stenosis in the neck.

12.20pm: He also says there is a serious athritis and stenosis on the neck where it will have a curve.

12.24pm: Sankara asks whether a person can have rigorous moving activity using the pelvic.

Hoogland: As soon as you go extending the painless thing and if you force the motion, there will be pain as certain motions are blocked.

12.27pm: Hoogland shows Anwar's MRI results taken in September 2011.

He points out the area where the fourth and fifth vertebrae is enlarged.

The witness also shows pelvis and the left side are slightly larger than right.

"It would see similar changes when we reached the age of 60 to 63 and result in limitation of motion.
"There is severity of athritis at lumbar 5 level."

12.36pm: He says there was in between the joints in the spine L4 and L5.

12.38pm: He show the athritis attacking Anwar's lumbar 4 and 5. Referring to the MRI scans, Hoogland shows there are bone spurs on both lumbar 4 and 5.

12.44pm: Hoogland says there are signs of arthiritis on the fourth and fifth lumbar resulting in pain.

12.52pm: The spinal canal in C5 and C6 is narrowing.

His diagnosis, there is degeneration of spine at various levels, partial function loss of lumbar 4 and 5, nerve root depletion in L (lumbar) 4 and 5.

"There is stenosis in C5 and C6. His main complaint is back pain."

Hoogland says physiotheraphy was suggested.

12.55pm: Sankara asks for a break and wants a copy of Saiful's in-camera testimony.

12.56pm: Judge Zabidin agrees and says the court will resume at 2.30pm.

2.37pm: Parties return to court.

2.50pm: Court resumes.

2.52pm: Hoogland diagnoses Anwar's condition as multi-segmental degeneration of lumbar spine.

He explains it is not the whole spine, but towards lumbar 4 and 5, where there is some liquid.

The witness says there is weakness in the foot and numbness to the left and it can be attributed to the L5 (lumbar) bone root.

The MRI scan done this year had earlier been tendered as evidence.

2.57pm: Hoogland explains that Anwar cannot do straight-leg raising tests properly as a result of his condition.

2.58pm: Witness says surgery has led to a lot of improvement, but the disease process has continued since the 2004 operation.

Sankara: He still feels pain since 2004?

Hoodland: We have achieved quite a lot of improvement, but the limitations is limited as there is arthritis, as it has slowly worsened his back.

3.01pm: After surgery in 2004, there was intermittent back pain.

3.03pm: Hoogland says after the operation, Anwar was left with arthritis. Between 2004 and 2008, a little more worsening has occurred.

"The most increased problem could have been in 2004 to 2008. We are dealing with three problems: nerve damage, stenosis causing a lot of limitation in his back, and the damage to the joint has caused the on-going problem."

Sankara: As well as arthritis?

Hoogland: Yes.

Sankara: Would he able to kneel without pain?

Hoogland: He needs to move slowly to prevent pain. As stated earlier, he has problems to bend 10 to 15 degrees.

3.09pm: Sankara asks next proceeding to be in camera.
3.10pm: Public gallery is empty as judge asks those not related to leave.

He said since there is no objection, and orders proceeding to be in camera.
Wan Azizah, however, chooses to wait outside instead of remaining to hear the proceedings in camera.

3.23pm: In camera proceeding finishes and public is allowed back in and. The proceeding for the day has ended. Trial to continue tomorrow at 8.30am.

Source: http://www.malaysiakini.com/news/177855