Dear patients! "That which changes, shall remain" J.Rainis. The hospital where we have been leasing our. premises since 1995 is being renovated.

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1 Dear patients! "That which changes, shall remain" J.Rainis The hospital where we have been leasing our premises since 1995 is being renovated. 1 / 9

2 The new home of our clinic will be in the medical centre headed by my colleague and friend Dr. Jānis Birks - Latvijas Jūras medicīnas centrs in Riga, Patversmes iela 29. We will start working in our new premises on 3 December 2018! Our contacts remain unchanged: Tel.: , / 9

3 Website: Dear patients and colleagues! We have good news and more good news! First, the new space of our clinic is wonderful, modern and well-equipped, so we could provide you with the best treatment possible. The diagnostic capabilities and the operating theatres are up to the highest modern standard! 3 / 9

4 It's all for you! Secondly, Kārlis and Sairita Puriņi are joining our team after 10 years of working experience in neurosurgery and patient care in the most prestigious clinics in Sweden! Welcome! It is important for patients not to experience pain, suffering, and fear! Miraculous devices, drugs or techniques most probably won't help! We will ensure experienced physicians, repeatedly verified approaches, compassion, attention, tidiness, and above all absence of waiting lines! Dear Patients! 4 / 9

5 Neurosurgery has been practiced by three generations of our family for more than 50 years. My father, Assistant Professor Ilmars Purins, was the founder of the Neurosurgery Centre at the Stradins Hospital and surgical treatment of radiculitis in the 60s and 70s was one of his principal areas of interest. I have been worked as an active neurosurgeon since 1979 and during the past 20 years I have been committed to radiculitis patients, and diagnostics and surgical treatment of the disease. Th ere is also the third generation of neurosurgeons in our family. It is Karlis Purins, who works and continues his studies at the Neurosurgery Residency of the University of Latvia and in a doctoral programme at Uppsala University in Sweden to become a well-educated neurosurgeon. In this letter to you, my dear patients, I will try to provide a brief explanation of the issues, assumptions and popular perceptions that have turned into folklore, which I have been hearing in my office for more than 30 years, and my ideas about the problem of radiculitis. Read well! R a d i c u l i t i s!!!??? Pain very unpleasant, drawing, throbbing, burning, spreading, at loads, at nights, in the daytime, when seated or standing, tantalizing, irritating and dull etc., etc. Restraint of movements it is difficult to bend or unbend, to seat, to stand up, to start walking; it is difficult to be in bed, to be at work, in a car, at the theatre etc., etc. People use to say I have osteochondrosis, I have ischias, my vertebrae are ruined, I have cracks in the discs, I have nerve constraint, I ve caught a severe back cold, I have a lumbago, my back is seized up etc., etc. How people doctor themselves they take medicine given by mom, rub some ointment on the skin, go to a bonesetter, have a massage, injections in the neck, blocks, and warming-up, stay at a health resort, try baths, sleeping on cabbage leaves, boards etc., etc. 5 / 9

6 Fine methods computer examinations, blocks in the back, visits to a manual therapist, intravenous infusions, using massage loungers, vertebral injections, laser therapy, etc., etc. Where the problems come from almost everyone who tries injections, ointments, warming-up, massage, bone-setting or even goes to quacks usually miss the main thing: establishing a clinical diagnosis and an academically correct medical examination!!! Where is the danger? The pain similar to radiculitis can appear in many other cases and you risk your health or even life without a correct diagnosis!!! Advice usually heard at the doctor s office: Try this or that medication tell them to try themselves. You need to understand what is going on with you, why do you suffer pain, what is the diagnosis and how to cure it. Start treatment immediately!!! They rely on experience and knowledge... That s OK. But you should request examination from the very beginning! If the cause is proven, then the treatment may be started! In case of possible radiculitis, in my opinion: 6 / 9

7 I. It is necessary to start with common measures for 1 2 days: a) bed rest; b) pain-killers, heat ointments, hot bath, baths, and do not hesitate to contact your family physician. II. If the above measures do not help: 1. visit your family physician or call him/her in; 2. ask your family physician to assess the clinical situation and prescribe examinations to determine the cause of your pain (blood and urine tests, X-ray of the painful area of the backbone, CT or MR examination or both according to the clinical necessity, electromyographic examination, and an advice of a neurologist, a neurosurgeon or an orthopaedist!!! these examinations is a modern minimum to be fulfilled in order to determine possible radiculitis. III. I believe that after a precise diagnosis is established, when drug therapy prescribed by specialists and physiotherapeutic procedures and treatment regimen does not provide improvement after 2 weeks, a neurosurgeon should be visited to decide upon further therapeutic approach! IV. Why it is not recommended to use charged services of diagnostic institutions without a recommendations of a specialist? 1. computer tomography devices differ fundamentally from magnetic resonance devices, and one particular or both examinations can be prescribed only by a practitioner familiar with a particular clinical situation. 7 / 9

8 2. blood and urine tests are essential for the diagnosis in case of radiculitis, as they help to determine the causes of the disease, the form of the clinical course, and often also concomitant diseases. 3. examination methods often are essential to establish a more precise diagnosis, e.g. electromyography helps to determine peripheral nerves and nerve radices involved and to distinguish several neurologic disorders, which imitate a compression syndrome etc., etc. 4. the sequence, the scope of examination methods, the need for special examinations and additional advice can be assessed only by a specialist!!! We often encounter extensive, independently executed high-class examinations, which appear to be of low information and often useless for determination of a patient s diagnosis. V. Remember that instructions of my colleagues on the phone have low medical value and can often cause medical problems chose a doctor who will treat you as a valued patient and who will have the time to examine you personally! Are all types of radiculitis subject to neurosurgery?! Definitely - NO! A top priority for a neurosurgeon is to assess your complains, clinical manifestations, to get acquainted with findings of the examinations performed by you or your family physician, to make a decision on the type, time and place of further therapy and to confide in specialists, ask 8 / 9

9 them all you questions regarding the disease, results and findings of examinations, treatment methods, their advantages and disadvantages, medical institutions dealing with surgical treatment of radiculitis, side-effects in the course of treatment, risks and possible complications of surgical methods, the applied types of anaesthesia, and, of course, the statistics of post-operative outcomes at the neurosurgery clinic of your choice. Remember that you can perform surgery on your problem also at another neurosurgeon s, thereby obtaining one more opinion, which may help you to understand the situation and to chase away your fears and doubts. I recommend you to look for a trustworthy neurosurgeon, who has received favourable references from your relatives, friends and colleagues, whom he already treated or operated. You should remember that you will be operated not by some hospital, unique devices or tools, but by the surgeon you choose yourself. If you are interested in details of types of surgery, methods, tools and devices, and if you nerves are strong enough to know all about it before the surgery, you should get medical education and then specialize in the neurosurgery. Only then you can try to understand all this. I definitely do not recommend going into details of these professionally complicated matters, but rather trust the professionalism and good faith of you surgeon! I wish you and us good luck! Sincerely yours, Juris Purins 9 / 9