| Monday, August 01, 2005 | |||
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Okay, here's another urrrm...I can't think of another word for it, ridiculous medical myth which I came across while I was still a fourth-year clerk. Our wards had rotating ceiling fans for ventilation. Our patients couldn't choose which beds they'd end up in, so it was a toss-up whether the fans reached them or not. I had one patient, a 12-year old girl, who unfortunately got the brunt of the fan on her face. Afterwards, I noticed that she always had a towel wrapped around her head. When I finally asked her mother why, the mother replied, "Para hindi mapasukan ng lamig ang ulo niya. Baka kasi magka-headache siya." To all ye non-Filipinos, her premise was this. Cold air can enter your head and cause headaches. The other patients and their accompanying relatives nodded seriously, as if this was common knowledge. Instead of cracking up on the spot, I patiently told them that no such thing would happen. Of course, the mother didn't believe me. She kept her daughter's head wrapped up anyway. Just in case. Okay. I'm not going to try and find out where she got this idea. I'm not even going to elaborate on why it's not possible in the first place. I'm just going to say this once. Cold air cannot enter your head and cause headaches by doing so. Enough said. Prescribe! The bill
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Okay, this post has nothing to do with medicine, so indulge me.
Prescribe! The bill
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Right now, I'm engrossed in gathering the requirements for my Internal Medicine residency application. It's a great big hassle, especially nowadays that we don't have a driver. Our driver, as some of you might know, recently underwent a CABG (a coronary artery bypass graft), because he was on the verge of a heart attack. My dad did the operation, and nearly financed the whole thing, too. Anyway, he says that Mang Nelson has to rest for about six months after the operation. That's, like, two months away, which is precisely why I'm stuck in the house. My friends keep telling me that I have to learn how to drive so I won't have to depend on anyone, but it's not like i can drive either of our cars, which are both SUV's. My dad keeps telling me that I can drive the Trooper. Duh. I don't even want to know how much that would cost me if I so much as scratched it. If I got a car to use as a practice vehicle, I'd prefer that it was small, second or third-hand, and cheap. Anyway, I'm still missing the S2 license, which would allow me to prescribe regulated drugs. I don't know why the heck I need it in the first place, except that it's listed in the requirements. As a first-year Internal Medicine resident, I don't expect to be prescribing such things for years yet to come. But, there you go. That damn S2 is causing me more trouble than all the other requirements combined. Because of it, I have to get my TIN (Taxpayer's Identification Number) ID, which, of course, I never applied for. That means that we had to drive about 20 kilometers away to the Bureau of Internal Revenue (this is a considerable distance when we're talking about the traffic in Manila), wait for more than an hour while the government employees took their sweet time getting back from lunch, only to be told that I couldn't get an ID because I had to update my registered-bloody-address. So the guy there gave me two forms, and told me to fill them up and give them to the BIR at North Quezon City. Fine. So we drove all the way back and proceeded to the establishment in question. And what happened? The--fortunately--nice lady there told us that we'd done it wrong; we should have had the three--not two!--forms processed back at the Manila BIR before submitting it to the BIR at South Quezon City. My blood started to boil. That was definitely not a good day. Anyway, that task finally got done. I handed the whole thing over to my helper because I didn't want to go through that entire hassle again. Thankfully, she survived this time, although we've been told to wait 3-5 days for processing before I could apply for my ID. Fine. I can still wait. The hospital I've been applying to doesn't even know the deadline for the residency application, which is a good thing, because that must mean it's still far off. I sure hope so. I haven't studied yet, and that fact is finally beginning to worry me. I should have at least a month left. That's enough. My next stop tomorrow: the compulsory urine drug test, which I could not take before because I had been taking slimming pills which could turn out false positive and give me a bad record at the Department of Health. Great. I'm so excited. Prescription (1) The bill
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| Sunday, July 31, 2005 | |||
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When you live at home with two noisy, boisterous kids aged 1 1/2 and 3 years old, you're bound to have to deal with a lot of shit. And I'm saying that literally. Kids tend to put anything in their mouths, even when it's not good for them. That leads to a lot of tummy trouble, and frequent trips to the bathroom. Fortunately, I'm not talking about myself. I'm talking about my boyfriend, who often has to deal with his sister's two kids without the assistance of domestic help. Of course, his mother's always at home, but she's hypertensive, and shouldn't be subjected to so much stress. Anyway, kids dehydrate very quickly, and become listless and lethargic. At any other circumstance, this would actually be desirable, but since they're sick, the correct response would be concern. So what should you do? Do not to give them anti-diarrhea medications like Diatabs or Loperamide or anything of the sort. That might actually be bad for them. The medications would force the kid's intestines to retain whatever they had eaten, even if they were toxic or spoiled. You would end up prolonging the illness, not solving it. The body is smart--it tries to expel bad things as quickly as possible. No; the danger here is dehydration and electrolyte imbalance, which is why the kids become weak. They should be given lots of water and Oral Rehydration Solutions, which are available in drugstores. Also, they should be put on a bland diet that is rich in potassium, what we traditionally refer to as the BRAT diet (Bananas, rice, apples, tea). Nothing oily, spicy, fatty, or exotic that could shock the stomach further. When I was young, I used to be given softdrinks and crackers by my yayas. Of course, I am now aware that this is wrong, as softdrinks are often too sweet, and crackers are too salty. These are just temporizing measures, of course, but they are very important measures. Kids can die from dehydration. That's precisely how cholera kills. If the kids get better immediately, well and good. But if the illness persists, they should be brought to a pediatrician immediately. Prescribe! The bill
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There is a long-standing belief that: Vigorous activity within two hours of a full meal is a risk factor for appendicitis. I don't know if anyone else aside from Filipinos believes this too. Actually, it sounds pretty logical if you think about it. The problem is, the new trend nowadays is Evidence-Based Medicine, which means that just because it's logical doesn't mean that it's true. The thing is, I've never encountered anything in our Surgery book--Schwartz--that says anything about post-prandial activity having anything to do with appendicitis. Believe me, I've looked. It just tends to run in families, and is more common in adolescent males and those with intra-abdominal tumors (Griffith's 5 minute Clinical Consult). Appendicitis is caused when something obstructs the appendix--most commonly a fecalith (which is an impressive sounding-name for a hardened piece of shit) or other foreign bodies such as worms (yucky but true) or seeds, and prevents the venous blood from draining. Of course, secretions accumulate inside the appendix too, till it becomes this small, red, swollen balloon that hurts like hell. That pain usually manifests first around your navel, then transfers after a few hours to the right lower quadrant of the abdomen. Anyway, the point is, there's no evidence that says you can't exercise after eating for fear of Appendicitis. But i'm not aware of any studies that have investigated this either, so better safe than sorry. Prescribe! The bill
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| Friday, July 29, 2005 | |||
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I don't know why it is that manicurists here in the Philippines remove the cuticle when tending to fingernails. Some of them seem to have a personal grudge against this little bit of tissue, and nip and tug furiously at it until every trace is gone. I suppose it's supposed to look cleaner. What a lot of people don't seem to realize is that we actually need the cuticle. It protects the nail, and the living tissue around it. Without the cuticle, the finger is much more predisposed to infection, which can be very painful, as a lot of people have found out through bitter experience. My boyfriend is an example. One day, his right index finger just became red, swollen, and tender. He ignored it, until it resembled a red balloon. Finally, he had to have it looked at. His doctor had to make a small incision on the side of his finger to let all the pus out. Ouch. So the next time your manicurista tries to take off your cuticles, don't let her. You just might be sparing yourself from a lot of pain. Prescribe! The bill
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This is, in my opinion, one of the most disgusting and incomprehensible superstitions that I've ever come across, namely: GIRLS SHOULDN'T TAKE A BATH WHEN THEY'RE HAVING THEIR PERIOD. I don't know how it originated. It must have dated back from the time when people didn't understand what was happening at this time of the month. They must have thought that the woman was bleeding from a wound (of course, she really is bleeding, but in a completely natural way), so they shouldn't try to make her worse by subjecting her to the dangers of cleanliness. This superstition may have something to do with the widespread belief that people shouldn't be allowed to bathe when they're sick. But that's another story. As I was saying, this superstition is definitely, absolutely wrong. At no other time of the month should the woman concerned be more aware of personal hygiene!! Blood is an excellent culture medium for bacteria and all other sorts of nasty things that breed and cause disease. Not to mention that it becomes extremely odorous after a short while. Not only are women allowed to bathe, they damn well should! More than once a day, if possible, in fact. And of course, change napkins/tampons/whatever frequently. Hehe, sorry guys, if this entry is a little icky and disturbing. But it had to be said. Prescribe! The bill
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Philtrum. That depression on your upper lip. Prescribe! The bill
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To this day, my Lola (Grandma) still fusses when it's already evening and I'm still out in the open. She would bustle out and try to pull me inside, saying "Sulod na, sulod na, sip-onon ka karun, matun-og na" (Come inside, come inside, you're gonna get a cold, it's already chilly). In vain do I try to reason with her that I'm not likely to get a cold, because there's one around but me. Contrary to what people think, colds are actually not caused by low temperature. Colds are caused by viruses which are aerosolized when sick people cough or sneeze. One good thing about some viruses is that if you get sick with one strain, you're not likely to succumb to it again. Cases in point: chickenpox and measles. That's why we're vaccinated with the dead or inactivated virus, so that the body can produce antibodies before we meet the real live healthy virus. Unfortunately, colds are caused by hundreds of viruses, so it's unlikely that we're ever going to get immune to it altogether. That's why there's no 'cure' for colds as of yet. A vaccine would also be impractical. I once read about a study in which the sample group was drenched and made to stand in drafty hallways. The control group was allowed to remain perfectly warm and dry. When they compared the incidence of colds in the two groups, there was no significant difference! Well, that doesn't mean that we should run about in windy places with wet clothes. Perhaps a drop in temperature does compromise our immune systems and makes us more susceptible to getting sick. So the final word? Keep warm and dry, and cover your mouth and nose when someone is coughing or sneezing. Lola was still right. Prescribe! The bill
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I keep hearing the phrase "lagnat sa loob", or internal fever. I'm not sure what that's supposed to mean. I guess it's the term that laypeople use when the patient feels sick but isn't warm to the touch. Medically, there's no such thing. Perhaps it refers to that in-between state when a person is in the process of developing a fever, and is showing all the other signs except for the elevation in temperature. For another thing, the normal bodily temperature isn't limited to a single number, which most people take to be 37C flat. It's a range, which varies according to whatever book you're referring to, what time of the day it is, and even which part of the body you're using. The axillary temperature, which we most commonly use, is actually the most inaccurate. Unfortunately, it's also the most accessible, so it's the one we use all the time. It's better to take the temperature orally, and best, rectally (though I doubt if the patient would appreciate your zeal for accuracy). For simplicity's sake, the range is usually between 36-37.4C. Below that, and the person may be in danger of hypothermia, or chilling. Above that, and the person may indeed be developing a fever. Antipyretics--or anti-fever drugs--shouldn't be given at once, especially if the person is elderly, or is taking a lot of other drugs. In the hospital, we only give the patient (adults) a tepid sponge bath when the temperature is 38.5C and below, with no serious accompanying symptoms. But if the temperature is above that, or the fever is really making the patient uncomfortable, then we start considering diagnostic tests or medications. Of course, the most important thing is trying to find out why the person has a fever in the first place, which is precisely why patients are urged to consult their physicians. Prescription (1) The bill
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