Slow Place, Quick Opinion

I drove to southern Iowa a few days ago to my new outreach clinic, which is about 70 miles (1 hour and 15 minutes drive) from Des Moines. After seeing all my patients there in the morning, I headed then to my other outreach clinic (still in southern Iowa) for the afternoon, which is about 30 minutes away from the first one. I visit these satellite clinics, outside of Des Moines, once every other month. (Most specialty clinics from bigger cities in Iowa reach out to many surrounding small towns to provide services.)

On the way to my afternoon clinic, since it was lunch time, I decided to get food. I passed a small rural town (estimated population: a couple of thousand people) and searched for a place to eat. I looked for something familiar and a restaurant that I knew would be accepting credit card, as I had only a few dollars in cash. Come to think of it, I rarely carry more than $20 in my wallet, as I exist by the swipe of the card.

small Iowa town (photo from New York Times)

I saw a Subway franchise restaurant and stopped there for lunch. The place is quite small and I thought to myself, since it was a small town, it must be a “slow” place. I wondered how can this franchise survive in this “remote” place. Sure enough, when I entered, there was no body sitting in the tables, though there were 2 people in the counter placing their order to-go, ahead of me. That would be OK, I would be eating in my lonesome, but at least a quiet meal.

After I got my order, I sat by the window in an empty restaurant all by myself.  However, I soon observed that one after another, cars started pulling up in the parking lot. A wave of people came trickling in non-stop. In a short period of time, the restaurant was bustling and full of people, and I felt like I was in a crowded downtown joint. Must be a popular place to eat. What did they do, invite the whole community for a lunch party?

As I left the place, there were several people seated in the tables, and there were 42 people (yes, I counted them!) in line, waiting to make their order. A “slow” place huh?

How many times do we quickly form our opinion and judgement on many things, just based on our first impression? And many times it turns out to be wrong.

Treasure in the Junk Mail

buried in junk mail

Few days ago, my wife cleared out all the letters, and junk mail in our table. As we received a lot of materials in the mail, most of them junk mail, they just piled up in our counter. Most of the time, I will separate the bills from the rest of the mail, and put it to my important mail pile. (Yes, all I am searching for in the mail are bills!) How funny that the only “important” letters we receive nowadays are bills.

As there are some personal information on the letters and even in the junk mail, my wife decided to shred them before she toss them away. As she was sorting the pile of papers and envelopes, she found an envelope with a check inside that amounts to more than $1,500 named to us. Yes, more than $1500! The check was sent to us more than 4 months ago. It was from our previous bank lender and it was given back to us, when we refinance our home to a new lender. We have mistakenly stacked it in the junk mail pile.

I cringe at the thought that we almost shred  and throw away  a nice sum of money. We have never thought that there’s something precious buried in that pile of junk letters. And we never even knew that we had it.

Sad to say, there are also other precious things in our homes that we are not aware of, or worse, pay no attention to. Treasures that are buried in the clutter of our busy lives. Valuable moments that are stacked upon by our preoccupation and distraction to “junk mails.” Constant deadlines, overtime at work, games and amusements, TV, computers, and other forms of entertainments heap over and bury this simple treasures.

A quiet family meal time together, a moment reading with your child, tutoring them with their homework, or time just playing with your children — these are the treasures I am talking about.

My son just entered the room with a chessboard in hand. I think I should finish this piece and heed my own advice.

Failed New Year’s Resolutions

Today is already the end of the first month of the new year. We blink and time will pass us by.

How long does a new year’s resolution last? A lifetime? The whole year? How about a few days to a few weeks.

Yesterday, I went to the gym. It was notable how different a couple of weeks made. It was not as crowded as it was a few weeks ago as I wrote in a blog before. Does that mean the people with resolutions to go to the gym and exercise, fizzled out already?

This is a classic example of human endeavor. We just cannot sustain our initial enthusiasm, nor can we finish what we started. Are we doomed to fail? Maybe this is the very reason why some people (that may include me) don’t make new year’s resolution at all: the fear of failing.

However, if we don’t at least make an effort to commit ourselves to change or make resolutions, then I believe that it is more dangerous, for we will not care at all. For me, it is better to make a resolution and fail, than not make one, or not care to change at all. I know no one can claim that he/she has no more room for improvement. For we all do.

Go ahead, try to quit smoking for the thousandth time. Try to exercise more regularly instead of once a year. Try to live more healthy. Try to stop chewing your fingernails. Try to blog everyday (I’m still working on this). Try to take a bath everyday or at least once a week (you have to, for the sake of the people around you). Try to be more patient and loving. Try to make more time for your family. Or just try to be a better person.

If we fail? There’s always the next year. We only really fail, if we completely quit trying.

By the way, who said you can only make resolutions during new year? Start one today.

Walk Fast, Live Long

(The original article is written for a local church newsletter.)

Fish were created to swim, birds were created to fly, and men were created to walk (although some are born to run). Even though most of the land creatures crawl or walk in all fours, human beings stand upright and walk on their two feet. From the dawn of history – from evading our predators, to the present – to strutting on the catwalk, moving on our feet is key to our survival.

We may not think of it much, but there is a lot of science, physics and physiology in standing and walking upright. How a creature can remain vertically steady against gravity without tipping over is already a marvel. And to move by shifting our weight from one foot to the other like an inverted pendulum and remaining perfectly balanced and straight up while walking is really amazing. Sometimes this equilibrium malfunction, like people who suffered stroke, and walking becomes a challenge. Indeed, we are fearfully and wonderfully made.

The most physiologic way of going from point A to point B for humans is by walking (not Segway). It is estimated that an average human being will walk 65,000 to more than 100,000 miles in his lifetime depending on his level of activity. (65,000 miles is almost 3 times the distance around the world.) The thing is the more we walk, the better. Unlike cars, humans last longer with higher mileage.

Studies have showed that the more active we are, the healthier we become, and the longer we live. In one study, researcher analyzed more than four decades of data from the Framingham Heart Study. They found that life expectancy at age 50 for people with medium activity was 1.5 years longer than those with low activity, while the high activity people live 3.5 years longer.

For most people, the optimum walking speed, that is the speed where our kinetic energy  is balanced with our potential energy, is around 3 miles per hour. We may not consciously think on how fast we walk, but our walking speed can be a simple reflection of how healthy we are, or how well our body systems are doing.

In a recent study that was published in Journal of American Medical Association this year, it stated that walking speed predicts life span and health. It was a meta-analysis of 9 separate studies of individuals 65 years or older. The study measured the walking speed of more than 34,000 seniors. They found that for every one-tenth of one meter per second increase in walking speed, survival rates for additional years increased exponentially.

Thus walking faster just not make you reach your destination earlier, or just make you appear that you are a man with a mission. It is also an indication of your longevity.

Let’s walk. And a little bit faster please.

Ang taong naglalakad ng matulin, (kung matinik malalim)………..buhay nama’y mahaba ang aabutin.

Winter Driving

Driving in the winter, especially in snow and ice, can be very challenging. There is no scarier moment in driving than when you turn the steering wheel to one direction but your car heads the other way, or when you hit the brakes but you continue to skid forward, or worse you start to spin. (I have experienced all of the above.)

We had snowstorm again yesterday and today, and the roads were dangerously slippery. There were few minor accidents in the road, that it took me more than an hour to drive to my work both days, a distance that I usually cover in 20 minutes. (I should not complain too much, for in Manila it takes an hour drive, a distance you can walk in 10 minutes.)

In one particular icy stretch of the highway today, I saw several vehicles that have fallen into the ditch. I have noticed that most of the vehicles in the ditch are either pick-up truck or SUV, which is counter intuitive. You would think that these type of vehicles will have an advantage in the snow. I guess the drivers of these vehicles had false sense of security and invulnerability and were driving at speed limit of normal road condition.

In my opinion, in winter driving, more important than the high ground clearance (like in truck and SUV), or the 4 x 4 or all-wheel drive, or by being equipped with winter tires — is using some common sense and a bit of caution.

Retiree’s Regrets

Few nights ago, our group had dinner with one of our former partners who retired a couple of years ago. He appeared healthy and fit than ever and he sounded like he was really enjoying the retiree’s life. After being in practice for over 30 years, he is content for what he had accomplished. When we asked him for some advice, he stated that he had only one regret: that he did not build better and deeper relationships. More meaningful relationship not just with patients, but with partners, other doctors, co-workers, employees and others.

Relationship. This got me thinking. How profound is that advice. Very true, that in our busyness, we don’t really take time to know people that we work with. We don’t know them enough nor we do care enough to know them. We are driven by our productivity, our deadlines, and accomplishing our jobs, that we have no time to build relationships with people.

I don’t think anybody at the end of their career would say, I wish I could have work more days in the office, or submitted one more project on time. Nobody in their deathbed would say, I wish I could have earned another hundred dollars, or another million for that matter. Our regrets would be something much deeper than these. When we are in our deathbed, our 401K, our financial portfolio and even our estate does not mean anything. It will be the relationships we establish with people, that will be treasured.

definitely not my estate

And it is not just the relationship with people at work that is suffering with our busy lives. Even the relationships that really matter, the one we have at home. Many times we forget why we work, and that is to provide for our family. Work is the ‘means’ to support the ‘end’ – our family. But sometimes the ‘means’ becomes the ‘end’, and the supposed ‘end’ (our family), becomes “the end.” How many families have broken because of too much work? Somehow our priorities are mixed up.

I know I will never be the best doctor in the world. I may never be the best doctor in our group. I may not even be the best doctor in our home (who knows if any of my kids will become a doctor someday). But I can be the best husband to my wife, and the best father to my children. And that is what I will strive to be.

I am thankful for the advice of an old and wise doctor. I wish at the end of my career, I will not have the same regrets that he had. Maybe mine would be: I wish I could have played more golf. But I don’t even know how to play golf!

Suwail sa Pamahiin: Barok Edition

1. Huwag ka kanta harap kalan ku ikaw dalaga, baka ikaw asawa tanda lalake.

Hindi masama ang umawit sa harap ng kalan o kapag ikaw ay nagluluto, at walang kinalaman ito sa pag-aasawa ng matandang lalaki. Ang katotohanan ay nakakaalis ng pagod at yamot ang pagkanta. Maliban na lamang kung saksakan ng sintunado kang kumanta; iwasang kumanta ng malakas lalo na’t may mga nakaririnig, at baka itulak ka nila sa kalan.

2. Huwag ka hakbang bata higa. Hindi ito laki.

Hindi totoong kapag ang batang nakahiga o natutulog ay hinakbangan o linaktawan ay magiging bansot ito. Sangayon ako na hindi magandang ugali ang laktawan ang iyong kapwa; subalit kung hindi maiiwasan, mas mabuti namang hakbangan mo sila kaysa iyong tapakan .

3. Ikaw salubong pusa itim, ikaw malas.

Hindi lang mga Pilipino ang naniniwala na malas ang makasalubong ng pusang itim. Ngunit sa Great Britain, para sa kanila, ito ay tanda ng suwerte. Kaya ipamigay o iligaw na ninyo ang lahat ng itim na kuting ninyo sa Britania.

4. Huwag ka kain kambal saging ku ikaw buntis. Baka ikaw anak kambal.

Wala po itong katotohanan. Ang panganganak ng kambal ay walang kinalaman sa iyong kinakain. Ang pagbubuntis ay wala ring kinalaman sa saging. (Hindi kasama sa usapan ang ibang klaseng saging na iniisip mo.)

5. Huwag ka walis ku me patay hangga hindi ito libing.

Hindi ko maintindihan kung bakit ipinagbabawal ang pagwawalis ng bahay kung may nakaburol na patay. Paano na lang kung isang linggo nang nakaburol at gabundok na ang alikabok at dumi sa bahay? Hindi ba mas masama kung hikain na ang mga taong nakikiramay dahil sa dumi at alikabok? Kung vacuum cleaner kaya at hindi walis ang gamitin mo? O baka naman magulantang ang mga naglalamay pati na ang patay sa ingay ng vacuum!

6. Huwag ka kain ku wala ilaw.

Ang pamahiin sa pag-iwas na kumain sa dilim ay sa paniniwala na baka may masamang espiritu kang makasalo. Bagama’t hindi ako naniniwala sa pamahiing ito, ay may praktikal na bahagi ito. Maaaring ikaw ay matinik o makasubo ng bubog, o butiki, o balyena, kung madilim at hindi mo nakikita ang iyong kinakain.

7. Huwag ligpit plato pag dalaga kain pa. Baka ito tanda dalaga.

Hindi magandang ugali ang pagligpitan o urungan ng mga plato kapag kumamain pa ang isang tao. Ito ay pagwawalang galang sa kanila, ngunit walang kinalaman ito sa kanilang hindi pag-aasawa. Pero may mga taong sobrang b…a…g…a…l…  kaya naiinip na ang mga kasama nila at sila’y pinagliligpitan na. Dahil sa kanilang kabagalan kaya sila laging napagiiwanan (pati kaya sa pag-aasawa?).

8. Ikaw sugat Biyernes Santo, hindi ito galing.

Walang katotohanan na kung ikaw ay nasugat sa Biyernes Santo ay hindi ito gagaling. Kung ito ay totoo, di sana lahat ng sugat ng nagpi-pinitensya tuwing mahal na araw ay hindi pa naghihilom hanggang ngayon. Wala na sanang mga nagpipinitensya kung ganoon.

9. Ikaw laki tenga, ikaw haba buhay.

Isang obserbasyon na ang matatanda ay may malalaking tenga. Marahil ito ay dahilan na pagtumatanda ay nawawala ang “elasticity of the skin and tissue”. Kaya pati tenga ay lumalawlaw at nagmumukhang mahaba o malaki. Ngunit hindi dahil sa malaking tenga kaya humaba ang buhay nila, kundi lumaki ang tenga dahil mahaba na ang buhay o tumanda na sila.

10. Huwag ikaw gabi suklay, baka ikaw kalbo.

Huli na ang lahat ng malaman ko ang buwiset na pamahiing ito. Maniwala ka, kahit sampung taon ko nang sinusunod ito at hindi na nagsusuklay sa gabi, ay naubos pa rin ang buhok ko!

Mga Payo Ni Barok

Bago pa naisulat ang makakatang tula ni Balagtas, at bago pa nalikha ang mga malalalim na salawikain ng mga matatanda, ay nauna muna ang kasaysayan at mga payo ni Barok. Dito kaya hinugot ang ating mga salawikain ngayon?

1. Pili ikaw pili, ikaw tapat bungi.

Nasambitla ito ni Barok matapos niyang mapangasawa si Gondina.

2. Ako tanim, ako, bayo, ako saing, iba kain.

Matapos ubusin ni Gondina ang sinaing ni Barok.

3. Ikaw ubos-ubos biyaya, ikaw bukas tunganga.

Nang simutin lahat ni Gondina ang lahat ng kanilang pagkain.

4. Ikli iyo kumot, ikaw tuto baluktot.

Matapos sarilining lahat ni Gondina ang kanilang kumot.

5. Ikaw a gipit, ikaw patalim a kapit.

Nang maghirap na sila Barok. Para kumita ng pera, sinubukan niyang kumain ng espada sa peryahan sa Korokan.

6. Diyos a awa, tao a gawa.

Natutong mag-sikap ni Barok. Naisip niyang magtayo ng sariling negosyo.

7. Huwag mo bilang manok, hangga hindi pisa iklog.

Payo niya nang mag-umpisa ang kanyang negosyong manukan (poultry).

8. Sino a putak, siya a anak.

Matapos mangitlog ang kanyang mga alagang manok.

9. Bayani asugat, lalo atapang.

Matapos masugatan si Barok sa pagtatangol sa kanyang mga manok, nang salakayin ang kanyang poultry ng mga asong gubat.

10. Ikaw wala tiyaga, ikaw wala nilaga.

Matapos maging matagumpay si Barok, at matapos niyang lutuing hard-boiled ang mga itlog.

Tumikwas kaya sa libingan si Balagtas? Itakwil kaya ako ng mga matatanda? O ipahuli kaya ako ng aking Pilipino titser sa aking kapangahasang palitan ang kasaysayan? Abangan sa mga susunod pang mga kabanata……..

Suwail sa Pamahiin: Ikalawang Yugto

Mawalang galang na po ulit sa ating mga matatanda, ngunit muli akong mangangahas na suwayin ang mga nakagisnan kong pamahiin.

bathing and washing in the river (photo courtesy from Baliktanaw)

1. Magsabi na “Tabi-tabi po”, kapag lulusong sa ilog o tatahak ng gubat. Ito ay paghingi ng pahintulot sa mga engkanto at mga espiritu na nakatira doon, upang hindi ka nila saktan.

Alam kong maraming Pilipino ang naniniwala sa mga engkanto, ngunit mayroon din namang hindi naniniwala sa mga ito. Isa na ako dito.  Sa aking pananaw, ay mas mabuti kung sa mga buwaya at ahas ka  mag-ingat, kapag tumatawid ng ilog at gubat. Mabuti ring humingi ng pahintulot sa taong may-ari ng lupa kapag tatawid sa lugar na may nakapaskil na “No Trespassing”, lalo na’t may kasunod na babalang “Beware of the Dogs”.

2. Magsabi ng “Pwera usog” kapag bumabati sa mga sanggol o bata, o lawayan ang kanilang pusod, para hindi mo sila mausog.

Ang paniniwala sa usog ay unique sa ating mga Pilipino. Walang scientific o medical na batayan ang paniniwalang ito, kahit marami nang pagsasaliksik ang naisagawa tungkol dito. Para sa akin, mas makakasama pa ang paglalagay mo ng laway sa pusod ng sanggol kung hindi pa tuyo ang sugat: hindi usog, kundi rabies ang maari mong maibigay sa bata.

3. Ang maliit na burol ng langgam sa ilalim ng bahay ay isang palatandaan ng magandang suwerte.

Hindi ito totoo.  Sa katotohanan, ito ay maaring sanhi ng peste, lalo na kung ang mallit na burol ay pugad ng anay o iba pang nakakapinsalang insekto. Kaya tumawag ka na ng exterminator. (Hindi Terminator, exterminator!)

4. Huwag sumipol sa gabi; ito ay pag-iimbita ng masamang espiritu.

Hindi ako naniniwala dito.  Ang masama para sa akin ay sipulan ang isang babae, lalo na kung kasama niya ang maton na boyfriend niya. Tiyak na bugbog ang abot mo. Huwag mo ring sipulan ang mga lasing na nag-iinuman sa kanto, kung gusto mo pang mabuhay.

5. Kapag nakagat mo ang iyong dila, ito ay tanda na may nakaalala sa iyo.

Hindi ako bilib dito. Ang mas maiging payo ay ang paalala, lalo na sa mga tsismoso at tsismosa, na kagatin ang iyong dila kapag ikaw ay natutuksong magsalita ng masama o manglait ng iyong kapwa. Ito ay tanda ng mabuting pakikipag-kapwa.

6. Iunan mo ang iyong libro sa iyong pagtulog upang ikaw ay maging matalino at palatandain.

Walang katotohan ito. Magkaka-stiff neck ka lang, lalo na kung makapal-kapal at hard-bound yung libro na iyong iuunan. Maari pang mabasa lang ng laway mo ang iyong libro.  Mas epektibo kung iyong babasahin at pag-aaralan ng mahusay ang iyong aklat. Ito ang magpapatalino sa iyo.

7. Huwag turo nang turo kapag ikaw ay nasa parang o nasa gubat, at baka ikaw ay ma-nuno (sa punso).

Hindi rin po ako naniniwal sa mga nuno sa punso.  Ang mas magandang payo para sa akin, lalo na sa mga misis: Huwag turo nang turo kapag kayo ay nag-wi-window shopping sa Mall, at baka ikaw ay iwan ng iyong mister dahil sa pagka-”Bilmoko” mo. Mas masaklap pa ito sa nanuno!

nuno sa punso (image from Wikipilipinas)

Ipagpaumanhin po ninyo sana ang aking kapangahasan. At kung magalit man sa akin ang mga engkanto at nuno sa punso, malakas ang aking loob, dahil alam kong wala naman sila dito sa Iowa. Kaya?

Debunking Folks’ Medical Advice

I have received and heard a lot of medical advices from my folks when I was growing up. And now that I have the title MD behind my name, I would like to weigh-in on some of those counsels. It is not my intention to be disrespectful to our elders, I would just like to examine if there is really medical truth on these ‘sage’ advices.

1. Huwag maligo kaagad kung galing sa trabaho o ehersisyo, at baka ikaw ay mapasma.

Don’t take a bath right after working or exercising, for it may cause “pasma” (sorry, no accurate English word for it, though the closest is “spasm”).

There is no medical truth to this. In fact most athletes take a shower after a strenous work-out. After working or exercising, your body heat production is high. This causes your blood vessels to dilate to dispense the heat, which make you look flushed, and your veins more visible. And I think the advice stems from the thought that bringing the body temperature drastically with a bath is harmful. But no studies have shown to support this.

It is then thought that a warm shower after a work-out is acceptable and probably will relax the muscles. But there has also been a practice by few elite athletes of taking an ice bath after an intense activity. The thinking is that the cold water will reduce the production of lactic acid (by-product of anaerobic muscle metabolism) and reduce muscle pain. Several studies published in sports medicine journal however have not shown benefits of the ice bath, but it has not shown ill effects also.

So with our current knowledge, taking a bath after work or exercise is not deemed harmful. For me it is more harmful not to take a shower, not to you, but to the health of others who have to smell and be suffocated by your body odor.

2.  Huwag maglaro o magtrabaho pagkatapos kumain, at baka ikaw ay ma-appendicitis.

Don’t work or play right after eating, because you might have appendicitis.

Appendix is a blind-ended tube connected in your cecum (part of large intestines). Appendicitis is inflammation of this organ when it is blocked by a fecalith. What  is triggering the blockage and subsequent inflammation is not very clear. However, it is definitely not by any activity right after a meal.

When we eat a meal, it takes 4-6 hours before our food leaves our stomach. Then the partially digested food particles will travel through more than 20 feet of small intestines, where most of it will be absorb. Whatever is left undigested will make it to the large intestines. So the food you eat now (or whatever is left of it), will probably arrive at the vicinity of the appendix by tomorrow. Not right after eating. You may feel sluggish though, especially after a large meal, as most of your blood circulation pools to your digestive system. So it may not be the best time to do your work-out also.

The bigger question is why do we have the appendix and what is the use of it. Nobody knows for sure, though some experts believe it contributes to the immune system. A research a few years back suggests that the appendix is a “safe house” for the good bacteria in the gut. If you ask my friends from surgery, they will tell you, that it is there for them to operate on.

3. Huwag kumain ng manok, o ng pakwan, kapag may malaking sugat. Ang mga pagkaing ito ay malansa at baka hindi gumaling ang iyong sugat.

Don’t eat chicken or watermelon if you have a large wound. Those foods are “malansa” (sorry again for no exact English translation, though “fishy” is close, but in this context, “dirty” is more appropriate), and your wound might not heal well.

Wound healing is dependent on many factors, like adequate blood perfusion to the site, nutrition, absence or presence of infection and others, like proper wound care.

Chicken is a source of protein, which is needed as building blocks for growth and wound healing. As long as it is properly prepared and cooked, I don’t see any reason that it will hinder wound healing. Watermelon on the other hand is rich in vitamins and anti-oxidants which are vital not just for wound healing but for overall nutrition as well.

So go ahead and gorge on watermelons, even if you have an open wound. Unless your open wound is in the stomach or GI tract, then it’s a whole different discussion altogether.

4. Matulog nang maaga para mas lumaki ka.

Sleep early so you will grow more.

The science of growth is very complicated. The growth process depends on the intricate interplay of genetics, hormones, nutrition, exercise, and possibly sleep. One hormone that affects growth is the growth hormone, which is secreted by the pituitary gland. This is released throughout the day, but studies showed that in children, it is released more intensely during stages of deep sleep.

While adults needs 7-8 hours of sleep a day, children needs more than this. Kindergarten or younger kids, need 10-12.5 hours of sleep a day, and older elementary kids need 9.5-11.5 hours of sleep. Inadequate sleep can cause growth problems, including slowed or stunted growth. Recent studies also showed inadequate sleep to be related to obesity.

If you are an adult and is way beyond the growth period, I don’t think sleeping more than 12 hours a day will add any more inches to your current height, and may just earn you a label of being lazy. However, if you are really requiring more than 12 hours of sleep a day and still sleepy, it’s time to seek medical advice.

So does sending your kids early to bed make them grow more? Yes, even with my board certification in Sleep Medicine, I have to admit that my mother was right.

Do you know of other folks’ medical advice? Let us investigate them if there’s scientific truth behind them. However, I know knowledge is power, but only if we show repect that we gain wisdom.