Tuesday, August 16, 2005

ZZZZZZZZZZZZZZ



   One traditional casualty of diving into Medicine is sleep.

   When you're a student, sleeping in becomes a luxury.  When you become an intern--and beyond--sleeps becomes synonymous with wishful thinking.
   
   When I was a med student, I slept at 4 hours max during ordinary days.  If we had an exam the following day, that would be cut down to 2 hours.  If we had finals, well...I'd mix up a batch of strong coffee, buy sacks of junkfood, and probably not sleep at all (you can now understand while I gained so much weight at this time).  

   On the day before the Med boards, we all had to wake up at 5:00 a.m. so we could get to the testing center as early as possible.  I slept at almost 3:30 a.m. that night, and grudgingly at that.  I kept stuffing my brain desperately with tidbits of information that I hoped I wouldn't forget once I woke up, even though I knew better. 

   It's actually better to study sensibly and then sleep adequately, than continue cramming long past the point of exhaustion. 

   Our brains continue working on problems even after we have gone to sleep. In one study, a group of people was allowed to sleep for eight hours before tackling a problem that had been described to them. Upon returning to the problem, the sleepers were almost three times as likely as the non-sleepers to find a solution to the problem. 

   Getting 6 to 8 hours of sleep per night can also make us 3 years younger than our biological age.

   Sounds like a lot of benefits for doing something we'd want to do in the first place, right?

   But if I ever had to take an exam again, I have no doubts about what I'll do. 

   Bring out the latte, Mom.

   


renzguerra liberated at 10:11 am
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Sunday, August 14, 2005

LAUGHING MAY BE DANGEROUS TO YOUR HEALTH



   Have you ever laughed so much that you couldn't breathe?

   Not because you couldn't catch your breath from excessive mirth.  But because your chest tightened, your throat closed up, and you started to wheeze like an amitious cat trying to sing the opera.
   
   Yes?
   
    I see.  Like me (and about 70% of my relatives), you must be asthmatic.

   There are dozens of triggers for asthma attacks, and a lot of them don't have anything to do with allergies at all.  Some examples:  a change in temperature.  Exercise.  And, as I've mentioned, laughter, especially the uncontrollable giggle and the belly laugh.

   It's actually funny.  Picture this scene (which has happened so many times during family gatherings that I've lost count):

   A dozen French Fries, mostly women, gathered around the living room.  Excuse me; I meant Potatoes, or scions from the maternal side of my family.  Someone tells a hilarious anecdote.  Everyone breaks out into hysterical laughter.  Within 30 seconds, someone begins to impersonate a  cat.  Seconds later, someone else chimes in.  Within five minutes, more than half of the people there are coughing, wheezing, and yet laughing at the utter ridiculousness of the situation.   It's almost sounds like an orchestra.

   To a doctor, this might look like a scene of potential disaster.  The probability of status asthmaticus (a continuous asthma attack that could become fatal) seems frighteningly high.  But everyone acts with aplomb.  As one, the afflicted members of the family reach into their respective purses and fish out their Albuterol inhalers.  They puff twice, wait a few minutes for the medicine to take effect, then continue on with the enjoyable conversation.

   Another ordinary event the lives of the Potatoes.
   
   I don't know why the medical world took so long to latch on to this phenomenonI guess it sounds ludicrous that laughter could set off something as potentially dangerous as an asthma attack.  But we've been dealing with it all our lives.  It's all a matter of preparedness.  That's why when you go to one of our family reunions, it's no big deal if you've forgotten your inhaler at home.

   Someone else is bound to have brought theirs.



renzguerra liberated at 01:30 pm
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Saturday, August 13, 2005

MY HERO



   Had a full day yesterday, which was why I didn't get to post until the afternoon.   

   I accompanied my Tomato to the the Rizal Hall of Malacanang Palace where he was given the Outstanding Writer/Reporter of the year award by the Volunteers Against Crime and Corruption (with members such as the tragically stricken Vizconde and Cervantes families). Hosting the glittering, nationally televised ceremony (it was live on Channel 4; unfortunately, we only realized that after the affair was almost over) was Cory Quirino. Also there was Rosebud (who turned out to be friendly with my sweetheart, and even commented favorably on my appearance), and some other generals and personalities whose names I have already forgotten.

   Guess who gave the award? It was President Gloria Macapagal-Arroyo herself, resplendent in red and tall(er) in stiletto heels. This was one complication I did not expect, and it explained the tight security around the place. She looks exactly the way she does on television. It was pretty ironic the way she stood there and smilingly handed out plaques and trophies to the awardees, a lot of whom were working actively against her. Near the end, she gave a long speech regarding her administration and the state of the country, punctuated by expectant pauses and rather reluctant applause.

   Unfortunately, you will not be able to find much about that affair on today's Inquirer except for a small footnote about PGMA saying something aboutjuvenile delinquents (link may not function after midnight). Trust her to steal the occasion by saying something controversial. Oh well, I guess it was too good an opportunity to pass up.
   We didn't stay for lunch. We had another engagement to cover: a press conference at Makati Shangrila hotel regarding drug counterfeiting and Viagra. Hmm. Interesting combination.  If you want to read about my reaction to that affair, just read my previous post (Smiley here).
   Accompanied Tomato to an internet cafe afterward, so he could type up his stories for the day.  I just clowned around taking pictures of him from all angles, then gave up and surfed on my own (while bugging him through the YM).

   After briefly strolling around at a nearby Powerbooks (and drooling at the gazillion books there that I didn't have the money to buy--sniff), we drove home tiredly through the typical EDSA rain and traffic, where I continued my penchant for taking pictures of the ordinary with my cellphone camera.
   


renzguerra liberated at 01:11 pm
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Friday, August 12, 2005

FAKING IT, HARD



   Hi guys.  Sorry if I'm a little late in updating today.  I just came from a very interesting product presentation and WHO forum.  The topic? 

   The Science of Better of Sex:  Viagra (Sildenafil Citrate).

   I can just see the guys clucking, shaking their heads, and wishing they'd been there.

   Actually, the presentation started out with ominous updates regarding the counterfeiting of medicines, which is on the rise.  According to their estimates, 6-10% of drugs nowadays are fake, especially those bought from unreliable sources such as peddlers, small stores, and websites.   Actually, that's a very conservative number, as I once read in a Reader's Digest article that the actual figure may be as high as 40% in some third-world Asian countries.  This may account for several instances of so called "therapeutic failure", when the patient's condition doesn't respond to the drug.  Maybe the "resistance" of several microbes to several stock antibiotics (which has been causing panic in medical circles) can actually be attributed to fake products.  We can't be certain, of course, because this problem is rather hard to track.  In any case, we are certain that this widespread counterfeiting has already cost many lives.  The majority of fake drugs don't contain any active ingredients at all, while others contain too little.  Others may contain the right ingredient in the right amount, but may be expired or mixed with toxic impurities that can be carcinogenic (cause cancer) or mutagenic (cause mutations).  I once read of an instance when a drug counterfeiting laboratory was found to be run by individuals who had AIDS and Hepatitis B.  A horrified shudder at this point would be appropriate.

   So how does this all connect with Viagra?
   
   Apparently, Viagra is one of the most faked drugs around.  There are many reasons for this, namely:

  • It's expensive, and that's almost an understatement.  One 50 mg tablet costs 560 pesos, which is equivalent to $10.00.  I don't know about you guys, but the only other drugs I've encountered which are more expensive are strong antibiotics.
  • Men afflicted with Erectile Dysfunction--especially Filipino men--are much too shy to tell their doctors about their problem.  It's a cultural thing.  They would rather self-medicate and risk the side-effects than tell anyone and suffer potential embarrassment.
  • Even the people who don't really need Viagra want to avail of it for sexual enhancement.
  • The incidence of sexual impotence is increasing because predisposing factors such as Hypertension and Diabetes mellitus are also on the rise.  It is estimated that by 2020, 185 million men in Asia alone will have Erectile Dysfunction.  

   Okay, so drug counterfeiting is a legitimate problem.  It robs patients and their families of both health and income.  It should be suppressed as much as possible, not just for the sake of lost revenue for drug companies, but also for the trusting consumers whose lives are on the line.

   However, I don't think that Viagra should represent the forefront of this campaign against counterfeiting.   It is still mostly just a lifestyle drug; hardly as important as the vaccines and the antibiotics that are also being bastardized in the market.   I found it disturbing that despite such emergent issues as burgeoning epidemics, worsening health-care and widespread poverty (which admittedly were not discussed in that forum),  the host (an MD) seriously called Erectile Dysfunction "The Scourge of the Century".    Even more disturbing was the fact that everyone actually nodded, laughed, and generally agreed.  I would think that we have more important things to worry about than a threat to good sex.  I guess the MD's there had no choice, as they were supposed to be representing the drug company's interests, but still...

   Perhaps if the audience had been composed of a different cross-section of society, the reaction would have been different.  But then, the MD might never have dared call ED the "Scourge of the Century" in the first place.

   



renzguerra liberated at 03:16 pm
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Thursday, August 11, 2005

DOGGY DIMENSIONS



   Okay, let's get off the boring subject of humans for a while.  Let's talk about...dogs!  Yup, man's best friend.  I just learned something very interesting about them.  For the longest time, I thought that a dog aged 7 dog-years per man-year.  Thus, a 7-year old dog is 49 years old.  However, according to my cousin, (who cites a doggie digest):

   A dog's life increments by 12.5 dog-years for the first two human-years, then increments by 4 dog-years per human-year thereafter.  For example:  a four year-old dog is actually 33 dog-years old.

   I'm vastly relieved.  In an earlier post, I mentioned that we had our 1 1/2 year-ol dog mated, and that she cried and whimpered all over the place.  If you calculate her age the usual way, that would make her way too young, right?  (I guess a lot of you are snickering right now.  I don't know much about dogs!)  But using the new formula, that would make her about 18, which is obviously more acceptable.  Whew. 
   
   Lastly, check out this page by Herb, concerning pets.  It's soooo funny.

  


renzguerra liberated at 08:12 am
Prescriptions (4)  

Wednesday, August 10, 2005

GOOD NEWS FOR THE HORIZONTALLY CHALLENGED


    Another myth busted.

   According to Jeffrey Kluger of Time Magazine, it is actually possible to be fat and fit at the same time.
   
   Apparently, being overweight may not be as dangerous as being inactive, according to Holter, Miranda, and Park of Time.  We all know that inactivity leads to obesity, and obesity leads to a slew of other health problems, such as diabetes, stroke, heart disease, sleep apnea, joint problems, and even cancer
      
   "It's not the number on the scale or the size of your khakis that will kill you, after all; it's the elevated blood pressure and cholesterol...that come with moving to the relaxed fit rack." (Time) 

   Being fit and fat isn't quite as good as being fit and lean, of course.  The fat itself, especially the 'visceral fat' around our middles which encapsulates our internal organs, releases inflammatory substances that contribute to diabetes and hypertension. Logically, the more fat we have, the more predisposed we are to cardiovascular problems and related diseases.  The good thing is, exercise helps combat some of the negative effects of this fat, making it possible to attain normal blood pressures, normal cholesterol and sugar profiles, and even normal aerobic capacity

   In layman's terms, that means that some active plus-size people out there might actually be healthier than slender and sedentary model-types.

 
   For someone who is active but has yet to lose a lot of weight (like me!!) that's really good news.

Exercise Tips for the Oversized (From Time)

1.  Short and Frequent
   Aim to exercise often, even two or three times a day, but keep the sessions short and sweet (10 to 15 minutes is plenty).  If it hurts, stop, and if you dread your workout, change it.  The pursuit of fitness should be a pleasure, not a punishment. 2.  Take care of your skin.
   One of the most troublesome problems large exercisers face is chafing, especially of the thighs.  Minimize the problem by wearing form-fitting clothes, preferably a synthetic fabric that whisks away sweat.  When it's time to hit the showers, use antibacterial soap and dry all body folds well.
3.  Be kind to your joints.
   Exercise can qualify as cardiovascular without giving your joints a pounding.  Take a gym spin on the recumbent bike, pump and elliptical trainer or enrol in a water-aerobics class.  Concentrate on strengthening upper-leg muscles, especially the quadriceps (the muscles on the front of the thigh).  That will, in turn, ease the strain on knees.
4.  Stretch Carefully.
   Limbering up is important for everyone, but overweight exercisers should staw away from stretches that strain the lower back, including that classic from gym class, the toe-touching drill.
5.  Mind your footwear.
   Sturdy running shoes usually offer the best support, even if you don't plan to run.  Be sure your shoes are roomy, an dkeep your toenails cut short.  Increased pressure on feet stuffed into sneakers that are too snug can lead to nagging problems with both nails and toes.


SAUNTER OVER TO DOC EMER'S FOR THE 46TH MEDBLOGGERS' GRAND ROUNDS, AND SOME 40+ OF THE BEST HEALTH-RELATED POSTS AROUND. ENJOY!!


renzguerra liberated at 07:57 am
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Tuesday, August 09, 2005

PSYCHIC POWERS AND STEM CELLS




   There are many superstiitons about the Caul, which is actually just the transparent placental membrane which sometimes covers the head of a baby when it is born.  In the Philippines, this is the prevailing belief:

   Babies born with a caul will manifest supernatural abilities and an open third eye (the ability to see ghosts).
  
   Many other cultures have attributed
strange powers to this membrane since time immemorial.  As the link shows, some seers practiced a form of divination with it, called Amniomancy.  It was said that a caul could prevent anyone from dying by drowning, so they were prized by sailors all over the world.  That cauls are considered lucky even among some superstition-scorning Christians is explained by the legend that even Jesus was born with one.
 

   Now, according to Medpundit, the Caul might very well turn out to have some miraculous properties after all; not by preventing drownings or bestowing magical abilities, but being the source of infinitely flexible stem cells that can turn into entire organs or tissues, thus sidestepping the issue of rejection which complicates transplants.  Countless lives could be saved or improved in the future.  This is certainly a viable option to all of us who strenuously object against the use of stem cells harvested from aborted fetuses.

   In a way, perhaps those seers and sailors knew what they were talking about after all.


renzguerra liberated at 11:31 am
Prescriptions (4)  

Monday, August 08, 2005

THE LADY WHO WASN'T THERE


   Now for something goose-pimple-inducing that doesn't involve Medicine...

  • Fond of ghost stories and scary movies?
  • Addicted to horror trains and mazes that disappoint you every time?
  • Like to drive by dark alleys with towering balete trees and reputed haunted houses during unholy hours, in the hopes that you'll see a white lady?
  • Do you actually want to open your third eye?

   If you answered yes to all of the above questions, you must have serious thrill issues.  Most of the people I know who can say "I see...dead people" deplore their gift.  But I know one person who would love to have a close encounter of the third kind with anything paranormal.   That's unusual; I love ghost stories too, but put me face-to-face with a real apparition and I'd probably faint.  On the other hand, Ian (not my Tomato) would probably thrust a hand out to the befuddled ghost and introduce himself.   

   Unfortunately for his strange preoccupation, he seems to be esper-blind, which is a term I read somewhere that seems to mean that your third eye is glued shut.  He has never experienced anything paranormal in his life, to his consternation.    I haven't been able to feed his avid curiosity with true ghost stories (mostly from my other friends, thank goodness) lately, so this is a treat dedicated to him.  Hoy Ian!  This is for you.

   He was used to driving home very late in the evening.  He lived a fair distance away from his girlfriend's house, and used a route that consisted mostly of dark winding streets.  To keep himself awake and preoccupied, he listened to the news or sang along to the songs belting out from his radio. 
   One night, he got home late as usual.  The gate was open, but the front door was locked.  He parked his car in the garage and knocked on the door.  His mother opened the door for him, froze for a few seconds, then hustled him wordlessly inside.
   


   It was only on the following night, while he was driving home, that his mother texted him the explanation for her weird behavior.  Upon opening the door for him the previous night, she had seen a lady with an open umbrella standing by his car.  The lady was quite distinct, from her face to her dress.  Then, she had disappeared.  His mother was quite convinced that he had brought the ghost home with himIn his car.
   Needless to say, no amount of singing or listening to the news could prevent him from nervously checking his mirror every few seconds that night. 
(As told by my Tomato himself)


renzguerra liberated at 09:29 am
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Sunday, August 07, 2005

JUST DUE



   A doctor, like any other human being who works for a living, deserves just compensation for his services.  However, how much he should actually receive has always been a matter of controversy.  There is no set standard which dictates how much a doctor should charge, so professional fees are pretty much arbitrary.  The doctor can set them himself, factoring in his education, expertise and experience.  Or, he can go by the standards of his colleagues, so that there is a semblance of fair play in the neverending competition for patients. 

   But what exactly does "just compensation" mean?  What else is someone supposed to factor in when computing the professional fee?  How about improvement in the quality of life? How about the increase in the patient's lifespan?  Are those ineffables considered too?  

   The factor that definitely shouldn't be considered is the doctor's current financial status.  The fact that he is building his house or dead set on buying a BMW shouldn't reflect on the patient's bill, right?  Of course.  But there are some supposedly professionals out there (who took the Hippocratic Oath along with the rest of us) who must think otherwise, judging by their actions.

   I know of a cardiovascular surgeon who had a patient referred to him by a general surgeon.  For simplicity's sake, let's call the TCVS Dr. Lopez, and the GS Dr. Del Monte.  The two doctors had been classmates back when they were still in Medical school, and were ostensibly friends.  The patient, a retired seaman who had been experiencing intensifying chest pains, turned out to have advanced Coronary Artery Disease.   He had savings from his lucrative former job, but the brunt of the expenses would be shouldered by his company.  Dr. Lopez gave him the less expensive package at the hospital anyway, seeing that the patient was elderly and had no close family.  The operation was a success.  The patient was soon feeling perfectly healthy and pain-free.  Grateful and delighted at the impeccable service, he asked for the bill so he could settle it and give the receipt to his company for reimbursement.   Oddly, Dr. Del Monte asked his friend how much the package was, saying that he wanted to collect the money himself.  Dr. Lopez gave a figure of 200,000 pesos, which was a fair price considering that this already covered the hospital fees for ten days' confinement and the fees of three other prominent consultants.  A few days later, Dr. Del Monte approached Dr. Lopez again and gave him the 200,000 pesos in cash.  He then asked for a receipt in return.  For 350,000 pesos.

   Dr. Lopez was nonplussed.  Why was he going to sign out a receipt for 350,000 when he had only received 200,000?  That was not part of the deal.  He asked for an explanation, which Dr. Lopez initially refused to give, saying that it was irrelevant.  Finally, at Dr. Lopez's insistence, the whole story came out.

   Del Monte had charged the patient 350,000.  Upon receiving the full amount in cash, he had then given the 200,000 to his friend and pocketed the rest as his 'professional fee'.
   
   Lopez  was stunned.  His 'friend' had not done anything to earn that extravagant sum.  Del Monte was a general surgeon, and had not assisted in the patient's management in any way.  He didn't even visit while the patient was in the hospital convalescing.  Further questioning disclosed what Lopez feared.  Del Monte was in the process of buying an expensive car which he didn't quite have the funds for.  Perhaps he wanted the money for down payment.  Of course, he wouldn't admit to such a thing, but he wouldn't explain why would charge so exorbitantly, either. 

   Lopez maintained his stand.  He would not issue a receipt for 350K when he had not received any such money, even for the sake of friendship; not because he was afraid of being caught, but because it was the wrong thing to do.  He would not help perpetuate such an unethical practice.

   The comical thing was, this reasoning never occurred to Del  Monte until Lopez spelled it out for him.  Del Monte thought that his friend was refusing him out of either cowardice or spite.  When he learned that it was out of integrity, he sputtered and completely lost wind.  Evidently, he thought that most of his friends subscribed to or tolerated this form of self-enrichment, instead of doing honest work.  He was wrong.

   To shorten a long story, Lopez never acquiesced to Del Monte's demands.  He wrote a receipt for 200,000 pesos only.  The GS eventually had to sign out his own receipt for the 150,000 pesos that he had pocketed, making his greed perfectly clear.   As expected, the company did not reimburse this additional expense.  The patient returned to the TCVS, fuming at his attending physician's treachery and hinting darkly of reprisal.  Lopez never heard anything more about it after the last check-up.  He hasn't heard from Del Monte since, either, after the latter suddenly and mysteriously left the country.
   
   So, on whose side would you be on?  Would you have two different answers depending on whether anyone could hear you or not?  It's easy to side with justice on the abstract.  But if you were in the same situation, and you had to consider such factors as friendship, loyalty to the profession and your colleagues, maintaining appearances, and the possibility of a suit...it's nowhere near as cut-and-dried.  That Dr. Lopez chose the right path anyway is a testament to his values, and a lesson to all of us who are striving to uphold the respect which comes with being called "Doctor".
   


renzguerra liberated at 01:56 pm
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FEAR FACTOR FOOD PART DEUX


      Hi again!  Find out exactly why those weird-sounding Filipino street foods merit a warning of 'eat at your own risk':

  • Staphylococcus aureus (Call me Staph for short)
       Hi.  You can find me on your airways, skin, and superficial wounds.  If food is left at room temperature for several hours, I quickly multiply and produce a toxin.  Cooking kills me but not my toxin (LOL), which is capable of producing explosive loose watery diarrhea and vomiting after 2-6 hours.  Hear about those children's parties where most of the children got sick that very night?  A lot of those incidents were my work, thank you very much.  Good personal hygiene while preparing food and refrigeration of foods:  these two practices are the bane of existence, as I won't be able to proliferate.But, there's always someone out there who's just careless enough...
  • Salmonella (Hi.  I like my name as it is.  It's so pretty, don't you think?  Why don't you name your daughter after me?)  
       There are lots of us in the intestines of birds, reptiles, and mammals.  You hear that? Intestines (Just think about that isaw or IUD that you had for merienda today.  Maybe I'm swimming around in your gut right now!).  I can also be found in raw eggs, and in water tainted with feces.  I can cause an acute form of gastroentritis (vomiting and loose watery diarrhea again, my two inseparable friends).  However, I am more famous for causing the dreaded typhoid fever which manifests with prolonged fever, diarrhea/constipation, and abdominal pain, which can keep you in the hospital for weeks.  Thank you, thank you, no applause is needed.
  • Escherichia coli (Call me E. coli for short.  That's pronounced Ee-Kolay)
       Even though I'm found in your intestines too, I can also be found in the intestines of other animals such as cattle.  Thus, I'm often transmitted by water tainted with feces.  I cause a severe, bloody, sometimes mucoid (you know that disgusting fluid that drips from your nose when you have a cold) diarrhea with painful abdominal cramps which can rapidly become much worse, so if you get these symptoms, you better get yourself to a hospital quick!
  • Vibrio cholera (Does my second name ring a bell to you?  I'm very popular in Africa.)
       I can be borne on anything you put inside your mouth--food or water, again if it it tainted with feces.  I've caused so many outbreaks since ancient times that I've killed more people than some wars.  The symptoms of extremely profuse watery diarrhea can start within one hour and can kill within three hours if not treated, especially little children, as my toxin can literally drain all the fluids from their bodies.
  • Shigella (I'm another one with an adorable name)
       I'm most commonly found on improperly handled salads (potato, chicken, seafood), raw vegetables, milk and other dairy products, and meat products especially poulty.  However, I can also be borne through feces-tainted water.  The diarrhea I produce is usually blood-tinged, or termed dysenteric.
  • Bacillus cereus (I love Filipinos and Chinese!)
       I can survive cooking as a heat-resistant spore and then proliferate when the storage temperature is incorrect.  I love starchy food such as rice, macaroni, and potato dishes (especially fried rice! Yum!).  Thus, if you don't want any brush with me, make sure you serve or reheat your foods to a very high temperature!


renzguerra liberated at 12:48 pm
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