Sakit sa Balakang: Final Answer

Mula nang aking isulat ang “Question and Answer: Sakit sa Balakang” bilang katugunan sa tanong ng isang reader, ay naging isa ito sa pinakamabenta na entry sa aking blog. Laging mahigit sa isang daan visitors ang sumisilip nito araw-araw.

Mahigit sa dalawampu’t pitong libo (27,000) na ang bumasa ng artikulong ito mula nang aking iakda ito noong Septyembre 29, 2016. Meron na ring mahigit kumulang isang daan (100) na readers ang sumulat sa akin ng katanungan na may kinalaman sa sakit sa likod at balakang simula rin noon.

Base sa mga bilang na ito, ay aking napag-alaman na marami pa ring mga tao ang naliligaw sa aking munting blog. Hindi pa rin naman nilalangaw at may sumusubaybay pa ring mga mambabasa. Marami pong salamat sa patuloy ninyong pagtangkilik.

Akin ring natuklasan na napakarami palang mga Pilipino ang may sakit sa balakang. Bakit kaya? Ano bang pinagkakaabalahan nating mga Pilipino at marami ang may sakit sa balakang?

Sa mga sumulat at nagtanong, wala namang nagsabi na sila ay nagtatanim ng palay. Alam kong maaring sanhi ng sakit sa likod at balakang ang pagtatanim ng palay. Ika nga ng ating folk song:

Magtanim ay ‘di biro, maghapong nakayuko,

Di naman makaupo, ‘di nama makatayo.

Sa lahat ng mga sumulat at nagtanong, ay akin naman po itong sinikap na sagutin sa abot ng aking makakaya, kahit halos magkakatulad naman ang inyong mga katanungan. Siguro kung talagang sumingil ako ng 5 choc-nut sa lahat ng nagtanong, tulad ng aking binaggit sa aking artikulo, ay marahil may ‘sangkatutak na garapon na ako ng choc-nut ngayon.

Ngunit hindi po ito tungkol sa choc-nut, o anumang bayad na aking sinisingil sa mga nagtatanong at kumukunsulta.

Akin pong inilathala ang artikulong “Question and Answer: Sakit sa Balakang” upang magbigay ng pangkalahatang kaalaman tungkol sa sakit na ito. Hindi ko po intensiyon na mag-diagnose ng indibiduwal na sakit ng isang tao, at lalong hindi ko po intensiyon na magbigay lunas sa indibiduwal na tao.

Isa pa, sa aking tingin, ay hindi po ligtas na magbigay ako ng espisipikong opinyon o diagnosis sa isang taong may sakit, lalo na’t hindi ko alam ang buong salaysay ng mga pangyayari, at hindi ko rin naman nakita o na-examen ang pasyente.  Sa halip na makatulong ay maari ko pa kayong mailigaw ng daan.

Dahil po rito, ay hindi ko na po masasagot ang mga magtatanong tungkol sa kanilang espisipikong sakit, o kung ano ang kanilang iniinda, o kung ano ang espisipikong gamot sa inyong sakit. Huwag naman sana ninyong ikagalit kung hindi ko na po sasagutin ang iyong mga tanong. Kahit pa isang buwang supply ng choc-nut po ang ialok ninyo sa akin.

Ang pinamabuting payo kong maibibigay sa inyo sa ngayon ay matapos ninyong basahin ang artikulong “Sakit sa Balakang” at kayo ay mayroong sakit na iniinda, ay magpatingin po kayo sa inyong lokal na duktor, at sila ang magda-diagnose at gagamot sa inyo. Sana po ay inyong maunawaan ang mungkahi kong ito sa inyo.

Maraming salamat po.

*********

PS. Sa mga nagtatanong din kung paano gumawa ng gayuma o ng anting-anting, o kung paano mang-kulam o labanan ang kulam, ay huwag na ninyo akong gambalain pa at hindi ko naman kayo matutulungan tungkol diyan.

 

Three Wishes for the New Year

I know January is almost half-way, but I hope this New Year’s wishes are not too late. My wishes for you, yes you who are reading this, are:

1. To remain in good health.

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Being healthy though is not an accident. It is a constant choice of having healthy habits and lifestyle. It is well-known that the top new year’s resolution is about getting healthier. We also know that membership to local gyms spikes in January. Unfortunately, some of the people who were so eager to “live healthy” at the beginning of the year fall off the wagon, so to speak, in a few months or even weeks after their resolution.

Joining a local health club might help motivate you, but it is not really needed to stay healthy, as there are a thousand other ways to do it. The key is sticking to whatever resolution you made.

2. To experience warmth and love in your family.

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In today’s society, in our pursuit of our dreams, sometimes we forget the more important things in this life. What does it mean to have a job promotion, or a better pay, or a bigger house, or a more luxurious ride, if our relationships with our spouse, or our children, or with our family in general are wanting?

Invest more time with your family, for that’s what really matters. Nobody in their deathbed wishes that they should have spent more time in the office or that they could have had a bigger TV. It’s the failed relationships that they are regretful of.

3. To live a life with a purpose.

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To have a meaningful existence, we should have a purpose in this life. Whether that be to climb Mount Kilimanjaro, or to save the Galapagos penguins, or to be the best shoe repairman in the world, or be the best dad to your children are all good ambitions.

That purpose in life cannot be decided by somebody else. You have to determine that for yourself.

Actually the above wishes and aspirations are for myself. But I’m glad to share them with you. May we all have a prosperous new year.

 

(*all photos taken with an iPhone)

Looking at the Horizon: A New Year’s Message 2018

(This message was delivered during a local church’s gathering on New Year’s Eve.)

In a few hours, we will be saying goodbye to this year and we’ll be embarking on a new year. Happy New Year!

The month of January is named after the Roman god Janus, the god of beginnings and of endings, and transitions. He is usually depicted as having two faces, facing back to back, one looking at the past and the other one looking at the future.

At this particular crossroad of time – the end of the old year, and the beginning of the new year – perhaps that’s what we ought to do: to look and evaluate the past, but also look and plan for the future.

Earlier this year, we were blessed with a trip to the Holy Land. We visited a place called Mount Nebo, which is located near Madaba, Jordan, or in Biblical times it is known as the land of the Moabites. The mountain is pretty high that it provides a panoramic view of the surrounding areas around it, including the land known as the Biblical Canaan.

As we were enjoying the view, the tour guide was giving insights and explaining the significance of this place to our group, while another group near us was having a devotional and they were singing the hymn “I am bound for the Promised Land.”

Where we were, is the place where Moses stood. And while Moses was looking at this same horizon that we were viewing, perhaps he was looking back at his life. But God also let him see the future and showed him the entire Promised Land, and the specific areas where certain tribes of Israel would settle. Since he was able to see details (recorded in Deuteronomy 34) that can only be seen with powerful binoculars, I believe God miraculously let him see Canaan with an assisted vision.

Yet the irony of this is, Moses never set foot in that land, for he died and was buried there in Mount Nebo.

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Moses, the chosen liberator of Israel, who led his people out of Egypt, and who dedicated his life leading the Israelites to enter Canaan, was not allowed to enter it. So unlike the song, Moses was not bound for the Promised Land.

Was Moses a failure then? Not at all!

Sometimes when we look at our past, we may feel that we are a failure, for we were not able to accomplish what we were supposed to accomplish. We may feel that we are losers for we are not where we wanted to be. Sometimes we feel like a disappointment for we started something but was not able to complete it.

Perhaps you’re thinking that you should have graduated from college by now, but instead you still have a couple of semesters to go since you shifted course. Or perhaps you’re thinking that you should have that high-paying dream job that you always wanted, but instead you’re stuck in a job you don’t really want. We may have started to work on a project, and now, it is still a project!

Friends, what we fail to understand, is that God may have some other plans for us. That God has a different destination for us, and we have just not realized it yet. Or God could have appointed you to begin that task, and He appointed somebody else to finish it. Just like in the case of Moses, where Joshua took over for him.

More importantly, when Moses stood there in Mount Nebo, while looking at the Promised Land from afar, he did not complain on why he was not allowed to enter the land that is promised to his ancestors, a land that was described as “flowing with milk and honey,” a destination I’m sure Moses wanted to be a part of. Instead, he humbly accepted God’s plan for him.

Moses may have not entered the Promised Land here on earth, yet God took him to a far better place, which is in heaven.

Jeremiah 29:11 – “For I know the plans I have for you,” declares the LORD, “plans to prosper you and not to harm you, plans to give you hope and a future.” (NIV)

As we stand here in the Mount Nebo of the year 2017, and as we look at the horizon to the year 2018, I pray that it will be prosperous for each one of us. I hope that it will be flowing with milk and honey. And for the lactose-intolerant, flowing with soy milk and honey.

As we set our goals for the coming year, may we not forget that all our plans here on earth are just temporary, for our ultimate destination is the Promised Land, the heavenly Canaan.

God bless us all, and again Happy New Year!

Don’t Lose Your Head

Perhaps you’ve heard of the advice that goes something like this: Be careful, or you’re gonna lose your head.

For some creatures, apparently this warning should be taken literally.

One morning last week, while I was working at our clinic, I noticed a praying mantis resting on our glass window. Our office room is one huge room that I share with my other partners.

One doctor partner of mine also saw the praying mantis and nonchalantly said that female praying mantis sometimes chomp off the head and eat their male partner after they mate or even while they are mating.

What?!!

I don’t think I heard that fact before. Maybe I was absent that day or missed that lesson during my biology class in high school and college. I know some creatures cannibalize their mates. The most notorious perhaps is the black widow spider, that’s why they are named such.

Other creatures that kill their mate after copulation includes the jumping spider, some scorpions, and some octopus. You probably have heard the song, “Love Hurts” by the rock band Nazareth. But for these creatures, love kills!

Our office secretary also overheard our conversation, and started ‘googleling’ some facts and videos about praying mantis.

I learned that mantids (plural of mantis) have 2 large eyes and 3 smaller ones and have stereo-vision. They can also rotate their head 180 degrees, enabling them to scan their whole surrounding. But maybe that’s the reason they are decapitated by their female mate, so they won’t look around anymore for another mate.

By the way, they are called “praying” mantis, because they have a stance that their front legs are folded like they are praying. The word “mantis” in Greek means prophet or seer. But don’t be fooled with this angelic pose, for they are deadly predators, preying on smaller insects. Bigger mantis can even prey on lizards, frogs, and birds. Yes, they prey even on their mates! They should be called “preying” mantis.

Such an opposite meaning between praying and preying. Do we sometimes give a different impression than who we really are? Do we hide horns underneath the halo? Maybe those mantids are just praying before they prey on their meal.

So back to my story, after hearing more facts from our secretary, courtesy of Dr. Google, we wondered whether the mantis on our window is a male or a female. Doctors can be very inquisitive, you know.

We learned that differentiating a male from a female praying mantis is quite simple. A male mantis has 8 abdominal segments, while the female has only 6.

So we looked closely on the praying mantis on our window whose belly is very visible to us. We determined that it is a male.

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praying mantis on our window

Doctors can determine the sex of the fetus or an unborn baby by looking at ultrasound images. They can determine the sex of a skeletal remains by anthropometric measures and bone features. They can even determine the sex where a tissue sample came from by doing genetic testing. But in our case, we also determined the sex of a praying mantis by simply looking at its belly.

After learning all these, we said to the mantis, “Be careful buddy, or you’re gonna lose your head.”

I guess, the warning applies to humans too, especially for the young ones. Many times we lose our head, in a sense that when the ‘love bug’ bit us, we lose our mind and we abandon our thinking brain, as we behave and act against all reasoning.

As Francisco Balagtas, a Filipino poet wrote long time ago in his work Florante at Laura:

O pag-ibig na makapangyarihan, pag pumasok sa puso nino man, hahamakin ang lahat masunod ka lamang.

(Love, all-powerful thou art, when you enter anyone’s heart, all will be abandoned, just to follow thy path.)

To all lovers out there, not just for the mantids, please keep your head.

*******

(*English interpretation of the excerpt from Florante and Laura is my own translation.)

 

Eclipsing the Eclipse

They said that it was the greatest show under the sun. The solar eclipse of August 21, 2017, billed as the Eclipse of the Century or also referred as the Great American Eclipse was visible within a band across the entire United States. The last solar eclipse that was seen across the contiguous United States was in 1918.

Where I live now, which is in Central Iowa, we only have partial eclipse, but it is still 95% cover. But if I want to see a total solar eclipse, all I need to do is drive about two hours west, or two hours south of me, and I will be in that narrow band of total solar eclipse path. Two hours travel is nothing. When I was still in Manila, it takes two hours just to cross EDSA.

There were places that I know that advertised their town or city as “the destination” for the best viewing area for the total eclipse. Their hotels were fully booked months before the event. I know some friends of mine tried to book a hotel on these popular places but were not able. Though they were still able to find hotels in smaller towns nearby.

In one place, they made their city parks and regional airport as the designated viewing place, but you have to reserve a spot for parking weeks before the event as they expect a wave of visitors. Of course there’s a fee involved. In another place, it was a military base that they assigned to welcome eclipse travelers, but again you need to reserve a slot there. Perhaps all the streets in these prime towns and cities suddenly have parking meters.

Even several weeks before the solar eclipse, I already knew that I am not working that day. It’s because I would be on-call the weekend before, so I am off that Monday. Thus I considered going to those prime viewing places. However, I learned that by that time, summer vacation is over and my children will be back in school already, and so I did not make any early plans.

As the event got nearer, and the hype for the eclipse got hotter, I thought that maybe we don’t even need to stay overnight in those choice places. I could easily drive early morning that day as it is just 2 hours away from us, and the time of the solar eclipse is not until around noontime anyway. And even if I have not made any parking reservation in those viewing areas, I thought I could just park in their town’s Wal-Mart.

Few days before the eclipse, I still have not procured the recommended glasses which is needed to safely view the solar eclipse. I tried to look for the certified eclipse glasses in the stores around our area, but all of them have sold out. I want to see the solar eclipse but I also don’t want to go blind. It was really poor planning on my part.

The weekend of my duty came. I worked and was on-call for an ungodly long time of almost 60 hours straight. Besides being so busy it was depressing too. In one stretch of time, we even had a string of deaths in the ICU that Sunday. I was just glad it’s over.

Solar eclipse by the way, for the superstitious, is regarded as an evil omen. The word “eclipse” comes from the Greek word “ekleipsis,” which means “an abandonment.” Thus it is not a surprise that civilizations throughout history associate it for bad things to happen.

Come Monday, the day of the eclipse, I was awakened by lightning and thunderstorm. I checked on the weather and found out that it will be raining the whole day in our area. Rats! So much for viewing the solar eclipse.

I also checked on those areas where I initially planned on driving to see the totality of the eclipse, and the weather forecast there was cloudy too for the whole day. Suddenly I felt bad for those people who made such elaborate arrangements and plans to view the solar eclipse, only to be disappointed by the cloudy weather.

I end up just visiting my daughter in her university which is also two-hour drive away. But it was north of us and going farther away from the band of the total solar eclipse path. I reasoned, If I’m not able to see the total eclipse due to the weather, at least I’m seeing my daughter.

When we arrived at the university, it was cloudy there too. The university have even arranged an eclipse viewing party. Outside the university campus, in the town center, there were also lots of kids and their parents gathered outside the public library with their lounge chairs and eclipse glasses. But all were disappointed, as the sun can be barely seen due to the cloudy skies.

Below is the best we were able to get a glimpse of the solar eclipse:

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The greatest show on earth was covered not by the moon shadow. But by the dark rain clouds. The eclipse was eclipsed! What a bummer!

Clouds are part of our lives here on earth. And so are disappointments. We can make all the elaborate plans for the future. But there is always that element of unknown that is beyond our control. All we can do is make the best of the situation.

It was still cloudy when we got back home. It even rained some more. But as the sun was about to set, this showed up in the sky:

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Sometimes, those rain clouds that disappoint us can also give us unexpected joy.

 

(*photos taken with iPhone)

Debunking Folks’ Medical Advice: Part 6

Here’s another installment on this series, which are among the popular posts in this blog.

1. Eat carrots, for it will improve your eyesight.

I am sure many of you have heard this from your parents and your grandparents. They even said that it is especially true for improving night vision. Or maybe you’re advising your kids this too, telling them this will prevent them from needing eyeglasses. The scientific proof? Have you ever seen a rabbit wearing glasses?

Although this sounds like just another way for parents to get their children to eat vegetables, there’s actually some truth to this advice. Whether or not eating carrots will stop the need for ever wearing glasses is not accurate though.

Carrots contain a massive amount of beta-carotene, a precursor of vitamin A. Sweet potatoes, squash, and green leafy vegetables are also good sources of beta-carotene. Vitamin A is needed to form the protein rhodopsin, a light-sensitive pigment found in the retina of our eyes.

Vitamin A is not only key for good vision, it is also essential in healthy immune system and cell growth. Though poor nutrition may be one cause, there are many other reasons that can results to eyesight impairment that may need correctional glasses.

The tale for eating carrots was propagated during World War II,  when the British claims that their pilot’s success in gunning down German aircrafts even at night is due to their carrot-enrich night vision, and thus encourage civilians to eat locally grown vegetables. They made up this propaganda to cover-up their recently adopted radar technology, and kept this invention a secret.

2. Wound from a rusty nail will cause tetanus.

Folks say that stepping on a rusty nail or any rusty object, can cause rust to enter the body, and lead to tetanus. This could include eating food cooked in a pot that has some rust on it. These are half-truths. Though I would not recommend using rusty pots nor stepping on rusty nails.

I remember our old car in the Philippines with some rust on it, that some friends jokingly told me that they might get tetanus from scraping into our car.

Tetanus is an infection cause by the bacteria Clostridium tetani. These bacteria or its spores are usually found in the soil or dirt. This bacteria can enter the body through breaks in the skin like cuts or puncture wounds, but it’s not the rust itself is the problem, but from whatever dirt with the bacteria or spores that may be hanging on to the rusty item.

Once tetanus infection sets in, this results in severe uncontrollable muscle spasms, like lock jaw or whole body stiffening. The bacteria produce a toxin that affects the nerve synapses that cause muscles to continuously contract or go into spasm. The disease unless treated can be deadly.

Vaccine against tetanus is universally recommended and is widely available. It’s part of the childhood immunization in the DPT (Diptheria, Pertussis, Tetanus) vaccine.

So you can still develop tetanus from stepping on a non-rusty stainless nail, if contaminated with dirt. Unless you’re adequately vaccinated against tetanus.

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Muscular spasms in a patient with tetanus. Painting by Sir Charles Bell, 1809

 

3. Don’t sit too close to the TV, it can damage your eyes, or harm you.

I was told this by my parents when I was little. I just thought that we were not supposed to sit too close from the television as something might come out suddenly from the TV screen.

I know my parents meant well. However this warning is kind of outdated now. It’s not really an old wives’ tale, but rather as an old technology’s tale.

The old television set before the 1950-60’s emitted levels of radiation, that after repeated and prolonged exposure to them, can cause some harm. But with later models of television that were built with proper shielding, the levels of radiation exposure is negligible.

Now that the TV sets that use cathode ray tubes (those bulky sets we have those days) are obsolete, we really don’t have to worry about emitted radiation from TV anymore. LCD and plasma TV don’t emit x-radiation at all.

Too much TV watching can still cause eyestrain though. Plus for young kids, there’s more fun things to do than watch TV.

4. Don’t crack or pop your knuckles, for this will cause arthritis.

According to one report, 20-50% of people, crack their knuckles. Many do it as a nervous habit. If you’re one of them, you probably have heard somebody warned you to stop, or else you will develop arthritis.

However there is no medical truth to this. And it’s not that it has not been studied. In one study, researchers look into more than 200 people, 20% of whom cracked their knuckles regularly. Of those knuckle crackers, 18.1% of them developed arthritis in their hands, compared to 21.5% of the study participants who did not crack their knuckles. So this study showed that development of arthritis is about the same, whether you crack your joints or not.

By the way, are you wondering what cause the popping sound?

When a finger or joint is extended like in an act of cracking your knuckles, the pressure inside the joint is lowered and the gases that are present in the synovial fluid, such as carbon dioxide, are released in the form of a bubble. This rapid implosion, collapse, or bursting of the gas bubbles creates an audible popping sound.

Even though knuckle-cracking has not been proven to cause arthritis, studies have shown that it’s not good either. In at least one study, chronic joint popping was shown to cause inflammation and weakened grip in the hands.

5. Don’t swallow chewing gum, for it can stick the insides of your intestines.

You probably heard this warning when you’re a child, or you told your kids this warning as well. Folklore suggests that it takes seven years for the gum to pass through the digestive system. However, there is no truth to this.

Certainly I have swallowed a few gum before, mostly not intentional but accidental. And obviously, nothing bad happened to me.

Though it’s true that the gum is indigestible, it’s not true that it will stick your insides, for it will pass through, with your stools within days, not years.

However there are rare reported cases of large amount of swallowed gum, combined with constipation, that caused blocked intestines in children. So I would still not advise to swallow your chewing gum. But if you accidentally swallow one, don’t sweat, it’s not that harmful.

Don’t scare your kids either that if they swallowed a watermelon seed, it will grow into a watermelon inside their stomach. Though if they are too young to understand how pregnancy happens, they might believe you that that’s from swallowing watermelon seed.

Question and Answer: Sakit sa Balakang

Recently I got a message from a reader posted in the comment section of my article Mamang Hilot, regarding a specific medical problem, asking for advice.

I have received several medical questions in this blog in the past, and most of the time, I just gave a short answer and recommended that they see their local doctor. I was also asked on how to make gayuma or how to counter a kulam, but of course I have no idea how to answer those.

Anyway, I decided to answer this reader in a post, regarding her medical question. Hopefully this would be helpful to her, and to some other readers with similar issues.

A reader, named Ellaine wrote:

Good day po.

Nagpahilot po ako dahil parang kumikirot ‘yung right side ng balakang ko. Pinadapa n’ya ako, dinaganan ‘yung balakang ko, saka hinila ang hita ko pataas at may tumunog. After ilang days, parang makirot s’ya at hindi nawala ang sakit.

May 3 linggo rin ang lumipas at saka ako nag-pacheck up sa doctor. Wala naman makita sa ihi ko na infection. Kaya niresetahan lang ako ng gamot for 1 month, baka daw kasi may na-damage na nerve o nabigla ‘yung muscle ko dahil sa hilot.

Natapos ko na po ‘yung medication ko, pero still masakit pa rin s’ya. And the worst, parang gumagapang ‘yung kirot papunta sa hita, binti, paa at likod ko, kaya natatakot po ako. Kahapon po bumalik uli ako sa doctor at binigyan naman ako ng x-ray request. Agad naman po ako nagpa-xray para malaman, ngunit wala rin po nakita sa x-ray.

Sabi ng doctor baka dapat na daw ako magpa-MRI, baka daw may naipit na ugat sa balakang ko. Sabi ko po wala naman akong kakayahang mgpatingin ng ganun kamahal, dahil nasa mahigit 10 thousand daw po ata iyun.

Pag-babalewalain ko daw po ‘yung nararamdaman ko, posible daw akong malumpo. Totoo po ba na talagang maari akong malumpo? Natatakot po kasi ako. Ano po kaya ‘yung nararamdaman ko at ano ang dapat kong gawin. Baka po may maitutulong kayo.

Maraming salamat po..

Dear Ellaine,

Sa aking pagkakaintindi sa iyong tanong, ang problema mo ay low back pain, na hindi natatangal kahit may isang buwan na ang nakalipas. Parang lumala pa ito kamo nang ikaw ay magpahilot. Paumanhin na lang po kay Mama o Aleng Hilot.

From the symptoms you’re describing here (pasensiya na po at nag-English na ‘ko), I believe you are suffering from lumbosacral radiculopathy. Don’t mean to sound high falutin, but this just means low back pain with possible nerve impingement (ipit na ugat) or nerve involvement, as you describe the pain as “gumagapang sa hita, binti, paa, at likod.” One specific condition is sciatica, which is impingement of the sciatic nerve.

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The nerve roots from the spinal cord as it comes out of the vertebra (gulugod), can be impinged by a muscle, or when there’s vertebral disc herniation, vertebral stenosis (narrowing), abscess or infection, or in rare cases, tumors. The nerves can also damaged by being stretched when certain physical injury or manipulation is done.

For all people with acute back pain though, the overall prognosis is quite good, as 70 to 90% of the time the pain will improve in 8 weeks or so. Very few will require invasive or surgical intervention.

Even though traditional thinking would say to stay in bed, the medical literature does not agree with this. Studies have showed that people who continue to be active, do better in dealing with their back pain and also have more shortened recovery time than those who did “bed rest.” Sorry, not an excuse to skip work. Though use common judgement when your work involves heavy lifting, like carrying sacks of rice or moving pianos.

Physical therapy when properly employed and specific exercises to strengthen the back and abdominal muscles can certainly help.

Medications like non-steroidal anti-inflammatory (NSAID), which I believe is what was prescribed to you is one of the mainstay of treatment. Sometimes it is combined with muscle relaxants. In severe cases of pain, narcotic analgesics can be used, but these are controlled drugs as they can be habit-forming or addicting. (Galit si Duterte sa mga adik!)

Non-medical intervention like cold or heat therapy to the area can be applied but mostly used during the acute phase of the back pain or injury. Massage, acupressure, and acupuncture (using long needles) have been employed but data on their effectivity is variable. Please don’t just stab multiple needles in your back.

Other procedures available are steroids injection to the spine and of course surgical intervention.

If you’re condition does not improve with conservative management (exercises, physical therapy and medication), then further work-up may be needed. Unfortunately, the imaging study to best visualize the structures in the back are MRI and CT scan of the vertebrae, which I agree are expensive tests. A plain x-ray will not be very helpful.

About the concern “na maari kang malumpo?” The pain na “gumagapang” does not necessarily means it is really bad. As I said most people with back pain recovers in time. However if you’re already experiencing focal weakness in your legs, like having difficulty climbing stairs or tiptoeing, then it can be serious. Kung hindi lang ‘yung sakit, at ikaw na ang gumagapang, eh seryoso na iyon.

So in the end, I would still recommend that you see your local doctor. An Orthopedic Surgeon or Physical Medicine and Rehabilitation specialist (also known as physiatrist) may be the best doctor to see regarding this problem. I’m hoping that you’ll just need physical therapy and a sprinkle of time to fully recover.

Hope this help Ellaine, and God bless.

Sige, padala mo na lang iyong bayad mo sa akin: tatlong Choc-Nut, ok na.

Pinoytransplant

 

(*sa mga susunod na kokonsulta, mas mahal na po ang bayad:  5 Choc-Nut na.)

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Post Script: Sa lahat po ng may katanungan pa, pakibasa na lang po ang aking article: “Sakit sa Balakang: Final Answer”

 

 

Running, Asthma and Darth Vader

Do you like running? But do you run out of breath and sound like Darth Vader when you run? Maybe you have asthma.

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Recently my cousin, who is a budding journalist in the Philippines, asked me questions on the subject of asthma and running, knowing that I am a lung specialist as well as a runner. He said that he was writing it for a fitness website. I would like to share them here.

1. How does asthma affect people? What does it do to their bodies?

Asthma is a condition in which there’s two main components, (1) narrowing of bronchial airways (bronchoconstriction) and (2) swelling (inflammation) causing edema and production of extra mucus. These can cause the difficulty breathing and wheezing, making you sound like Darth Vader. These attacks can be intermittent and reversible, and triggered by exposure to certain allergens.

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2. Can everybody have asthma?

No. It is most likely genetic or familial predisposition that leads to one’s having asthma. For example, there are certain triggers that can cause an asthmatic attack, like house dust mite, but not all people will react to it. It is like an allergic reaction, where a predisposed person’s immune system overreact to the trigger.

So if you have asthma, you can partly blame your parents and the genes they passed on to you.

I’m not sure if Luke Skywalker have asthma too (“Luke, I am your father” – Darth Vader).

3. What are the common causes of asthma?

There is a wide gamut of asthma triggers and can differ from person to person:

A. Inhaled allergens – like house dust mite, pollen, cockroaches (I hate cockroaches), indoor and outdoor fungi/mold, pet dander (I feel sorry for pet-lovers if their beloved pet cause them their asthma attacks).

B. Respiratory infections – common cold and other viruses, or bacterial infections

C. Inhaled respiratory irritant – cigarette smoke, pollution and smog (like in Manila!), certain chemicals like volatile gases that can be at the work place, and even (cheap?) perfume. If you have a co-worker that has a body odor, you can tell them to take a shower for it can trigger your asthma. Just kidding.

D. Hormonal fluctuations – like in pre-menstrual and menstrual period in women; it can be part of pre-menstrual syndrome!

E. Medications – like beta blockers (metoprolol) that is use as an antihypertensive or in heart patients.

F. Physical activity – exercise

G. Emotional state – anxiety, sudden upsets. Yes being dumped by your girlfriend can cause an asthma attack!

H. Temperature and weather – cold air, hot humid air, wet conditions (which can increase respiratory allergens in the air).

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4. What are the symptoms of asthma?

Most common symptom of asthma is difficulty in breathing, with sensation of chest tightness. You feel like you have a rubber band around your chest. When more severe, wheezing ensues. If really severe, it can lead to respiratory failure. A persistent cough can be a symptom of asthma as well, which is from the constriction of the airways.

5. Can it be prevented?

Yes. Avoiding the triggers as what I mentioned above. Also by using medications such as inhalers, especially the inhaled corticosteroid that kind of stabilizes the membranes of the respiratory tract of an asthmatic, so it won’t be so reactive. This lessen the attacks.

6. What’s the cure for asthma?

No cure for asthma. If you have it, most likely you’ll have it for life. Sorry Darth Vader. But we can control or minimize the symptom or lessen the attacks through avoidance of triggers and through medications. Asthmatics can do whatever they want and can live a “normal” life if their asthma is well-controlled.

7. Can running trigger asthma?

Yes. As any other form of exercise can.

8. Can a person still run if he/she is an asthmatic?

Yes. Even though exercise is a potential asthma trigger, it should NOT be avoided.

9. Can running help a person fight asthma then?

Yes. Aerobic exercise strengthens the cardiovascular system and may lessen the sensitivity to asthma triggers.

However, it is important for persons with asthma who are not in a regular pattern of exercise to build-up their activity level slowly to minimize the risk of inducing asthma. Also, if exercise is your asthma trigger, use your “rescue” inhaler (like albuterol meter-dose-inhaler) 5 -10 minutes before you exercise to preempt the attack. And if you have an attack while exercising, you can use the inhaler again.

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Jackie Joyner-Kersee, an Olympic medalist, uses an inhaler after running

10. Can a person run if he/she has an asthmatic attack or episode?

Yes and no. If the asthma attack is pretty mild, you may be able to endure it. However if the attack is significant that you’re wheezing, I would recommend to take it easy for that day.

11. How long should a person run after he recovered from an asthmatic attack?

No fast rules. You can sense when you’re ready. Listen to your body.

12. What’s your advice to people with asthma who wants to enjoy running?

Continue running. But you may want to run when it is not so hot and humid, (or too cold if you’re not in the Philippines). Or run in areas not so polluted or smoggy. That is maybe doing it early in the morning.

Also avoid stray dogs. Not because it can trigger your asthma, but it can chase you!

13. What should runners with asthma remember during their runs?

Have your rescue inhaler handy during your runs. It easily fits in even the smallest pocket of a running shorts anyway.

If there’s a lot of dogs in your area, you can carry a pepper spray too to ward them off. Just don’t mistake it for your inhaler!

And most importantly, have fun!

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This is how to defeat asthma and Darth Vader.

(*photos from the net)

Busting the Sleep Myths

As a society, we are 24/7 and driven by productivity. With the night time being the new frontier, our culture just doesn’t want to go to sleep.

According to the documentary “Sleepless in America,” a collaboration by National Geographic, National Institute of Health and The Public Good Projects, 40% of American adults are sleep-deprived, and the average American sleeps less than 7 hours per night.

As a sleep specialist, I was interviewed by our city’s newspaper* last week, regarding sleep issues and pervading myths about them. Here are what we discussed.

Myth #1: Chronic sleep deprivation won’t dramatically harm health.

Fact: Not getting your ZZZZZs can cause obesity, Alzheimer’s disease, mental illness and depression, diabetes, cardiovascular disease, and possibly even cancer, studies show.

When we don’t get enough sleep, our body releases a hormone that makes us feel hungry or not satisfied, so we’re likely to eat more. When this happens day after day it can lead to obesity.

Lack of sleep can cause insulin-resistance leading to diabetes. It can also impairs memory and many of the mental illness known includes sleep problems.

Myth #2: A nap disrupts sleep at night.

Fact: Short naps lasting 15 to 30 minutes are good for you.

Our normal circadian rhythm causes a dip (in energy) every afternoon sometime between noon and 3:00. A short nap, research shows, can improve functionality.

However, naps lasting more than 30 minutes produce a deeper level of sleep. Those are more difficult to awaken from, can leave you feeling groggy, and definitely make it harder to get to sleep at night.

nap at work

Myth #3: You have more important things to do than sleep.

Fact: In the 19th century people slept nine or 10 hours a night. Now we average just six or seven hours a night. Of course they don’t have television and internet in those days. Now we have developed this thinking that sleeping is a waste of time when that’s not true.

Adequate sleep benefits your mental sharpness and mood. It provides the energy that allows you to accomplish more during the day.

Myth #4: Some people do fine with less than 7 hours of sleep.

Fact: Most sleep experts agree that nearly everyone needs between seven and nine hours of sleep per night.

Some people may function well with fewer than 7 hours of sleep, but that’s not the norm. That said, studies indicate nearly 30 percent of Americans sleep less than six hours. That can increase risk of early death up to 12 percent.

If you fall asleep within five minutes after your head hits the pillow every single time, that may be a sign that you are sleep deprived. So unless you are a Giraffe, which only sleeps an average of 2 hours a day, you better get more hours of sleep.

Myth #5: You can catch up on sleep on weekends.

Fact: When you sleep deprive yourself, your sleep debt increases each day. You need to pay it back within the next day or so, not delay to the weekend.

The problem with “banking sleep” until the weekend is that sleeping in usually causes you to be awake later that night. Come Monday morning, you’re apt to start the week already sleep deprived, and the vicious cycle continues.

Myth #6: Driving when tired is okay as long as you drink plenty of caffeine.

Fact: Fatigue is the No. 1 cause of high-severity car crashes.

Although caffeine can help fight fatigue, it takes at least 30 minutes before it takes effect. If you’re awake for 17 or 18 hours straight, your reflexes are so slow it’s as if your blood alcohol level were .05 percent. You’re as good as drunk.

sleep pals

Myth #7: Teens don’t need to sleep in like they do.

Fact: Staying up late and then wanting to sleep in is really not teenagers’ fault entirely. Their physical-mental-behavioral “clocks” ― called circadian rhythms ― are to blame.

Teens’ circadian rhythms are delayed a bit, which is known as Delayed Sleep Phase Syndrome. They don’t usually feel sleepy until midnight or later, but then they don’t want to get up in the morning. That’s not a problem until they need to follow society’s schedule for school or work.

According to “Sleepless in America,” teens who sleep more hours do better in school and has less rate of developing depression.

To help teens achieve wakefulness in the morning (which helps them fall asleep earlier at night), more exposure to sunlight or light therapy can be recommended. This helps reset their circadian rhythm to be more alert earlier in the day.

Myth #8: Shift workers adjust to their work schedules.

Fact: No one really gets used to shift work. Humans are diurnal creatures, meaning they are wired to be active in the daytime. Except Batman maybe.

But in our round-the-clock society, someone has to work the graveyard shift. For those who do, these tactics will help improve the quality and duration of sleep:

  • When going home from work in the morning, try to avoid light, which stimulates wakefulness. Put dark sunglasses on.
  • When sleeping during the day, make sure the bedroom is cool and dark. Turn off your phone. Minimize all the things that can disrupt sleep.
  • When working at night, make sure you’re exposed to light and that your work area is well lit.
  • If you’re sleepy when working, using your break for a quick nap can really help.

Myth #9: You just have to live with your current sleep habits.

Fact: Many people have had poor-quality sleep for so long they believe nothing can ever change it. Not true.

Poor sleep habits can be very hard to break, but they can be broken. It starts with educating ourselves on how important good sleep is, and how it will benefit us in the long run.

So there you go folks, unless you are a Christmas elf, you should not ditch sleep tonight.

sleeping hippo

(*photos taken from the web)

(**post note: above interview was published in The Des Moines Register on January 11, 2015)

Debunking Folks’ Medical Advice: Part 3

We Filipinos have traditional medical beliefs that our elders have passed on the us, and we in turn passed on to our children. However, not all of these folks’ advices are scientifically or medically sound.

This is part 3 of the series that I have written here. It is not my intention to disrespect our elders but just trying to bring light to the truth, and nothing but the truth.

1. Huwag bunutin ang puting buhok, dahil lalo itong dadami. Sa isang buhok na binunot, sampung puting buhok ang magiging kapalit nito.

Don’t pull out white hair, as they will multiply more. One white hair pulled will cause 10 more to grow.

There is no medical truth to this. Melanin is the pigment that gives color to our hair. Hydrogen peroxide which our body naturally produces interferes with melanin. Our body also produces catalase, an enzyme that breaks down the hydrogen peroxide. As we age, catalase production tails off, and thus there’s more unbroken hydrogen peroxide that makes our hair gray or white. It was also found that gray-haired people have less hair-repair enzymes in their follicles.

The observation that the more you pull out the white hair the more white hair appears, is simply because of the natural progression of hair turning gray or white. It has nothing to do whether you pull it or not.

There’s one thing for sure though: the more hair you pull, the less hair you’ll  have. So it is better to dye them black, when there are too many white hair to pull. Or better yet, wear your gray or white hair with pride, as a badge of honor and wisdom.

2. Huwag hawakan ang palaka, at baka ka magkakulugo.

Don’t touch a frog, as it can cause warts.

Warts are caused by a viral infection. More specifically, the human papilloma virus. The virus enters through a break in the skin and causes cells to grow quickly on the external layer of our skin, causing the warty bump.

Frogs and toads sometimes have “wart-like” bumps in their skin, but these will not cause warts if you touch them. Though the bumps behind the head of some toads contains poison and can irritate the skin if you touch them. So it may be better not to touch them anyway. Don’t kiss the frog as well. It will not turn into a prince.

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3. Magsuot ng itim na damit kung may mga pantal, upang mawala ang pamamantal.

Wear black or dark-colored dress to get rid of skin rash or welts.

Skin rashes and welts are mostly caused by an allergic reaction. We can get allergic reaction from almost anything – foods, medications, soaps, lotions, perfumes, and other chemicals you can think of that we get in contact with. The rashes and welts are caused by the release of histamines and other bioenzymes our body produces that causes inflammation. Some of these allergic reactions can be serious and life threatening, while some causes minor discomfort only.

Wearing black or dark-colored clothes will not stop the allergic reaction, nor will it hasten the disappearance of the rashes and welts. If the allergic reaction is severe, that is besides the skin welts, you also experience swelling of the face and difficulty breathing, you better seek medical help quickly. Or your family will be wearing black for funeral.

4. Huwag maglakad ng naka-paa, at baka magkaroon ka ng varicose veins.

Don’t walk barefoot, as you may develop varicose veins.

Varicose veins are abnormally thick, twisting, and enlarged veins. They can form anywhere but are particularly frequent in the legs. Veins have valves within them that prevent back flow of the circulation. If these vein valves are defective or damaged, these will lead to varicose veins.

Experts believe that varicose veins can be an inherited condition, though there are a lot of factors that can aggravate them. Pregnancy, obesity, prolonged standing, constant straining (like in constipation) or anything that causes increased pressure that prevents venous blood return from the legs. Prior surgery or trauma, and aging are also factors. Walking barefoot though is not one of them.

In fact, recent studies have shown benefits of walking barefoot, like better biomechanics and muscle development. Though I’m not recommending you ditch your shoes yet, especially if you’re walking in city streets.

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5. Huwag maglakad ng naka-paa, at baka magkaroon ka ng bulate sa tiyan.

Don’t walk barefoot, as you may get intestinal worms.

This advice has truth to it. Though there are different ways that parasitic worms get into our body, there is one type – the hookworms – that can enter through our feet. People usually become infected with hookworms by walking barefoot on soil that contains the larval form of the worm, although infection may also occur from any other soil-skin contact or by ingestion.

Hookworm larvae move from the skin to the lungs and then the trachea, where they are swallowed. Larvae mature into adult worms in the intestines, where they attach to the intestinal walls and lay eggs. The eggs exit the host body with feces and once in the soil hatch into larvae, continuing the life cycle. I am sorry if I gross you out.

I know I have said that there are benefits of walking barefoot, but there are also disadvantages. This is one of them. So the next time your mother orders you to wear your slippers when you play in the streets (especially in Manila), you should listen.

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(*photos from the net)

Related Posts:

Debunking Folks’ Medical Advice

Debunking Folks’ Medical Advice: Part 2