Illusive Hope

During my last weekend call, one of the many admissions I had to the ICU was a man in his 70’s, who was found unresponsive in his home. Since he lives alone, he probably have been lying on the floor for a couple of days before he was found.

After work-up in the emergency room, it was determined that he had a large stroke. As he was very sick and unstable, we were consulted to admit him in our ICU.

The next day, after providing supportive measures, his vital signs stabilized and he became more responsive, and even following simple commands. Yet he still has significant neurologic deficits due to the devastating stroke.

The patient’s son who was the power-of-attorney, talked to me and showed me his father’s living will, which specifically detailed that in case he had an “irreversible condition,” he does not want to be on any form of life support including artificial nutrition, like tube feedings or even intravenous fluids.

I assessed that with the severity of the stroke, the likelihood of “good” recovery was doubtful. My projection was that he would never live independently again, would most likely be nursing home-bound, and definitely would not be the same person that they know. In addition, he could even get worse as the swelling of the brain increase. No question, I painted a grim scenario.

After hearing my assessment, the patient’s son and family, were ready to call hospice and just make the patient comfort cares. The son told me that his father, for sure would not like to live a life with such a poor quality as I have projected. Though I told them, that the neurologist whom I consulted have not seen the patient yet, and perhaps they should wait on what he has to say.

Not long after, the neurologist came. He extensively reviewed the CT scan of the head, and he made a careful and detailed neurological examination of the patient, as he tried to evoke even obscure reflexes that I can only read in the medical textbook. After his evaluation, the neurologist, the patient’s son, and me, went in a room for a conference.

The neurologist explained that with his estimation, even though the stroke was large, since it involved the non-dominant side of the brain and mostly the frontal lobe, he believes that the patient can still have a “meaningful” recovery. In addition, since the acute stroke was a few days ago, he thinks that the swelling was on its way down, and perhaps we were already past the worst phase. He backed this with his expert knowledge of brain anatomy and function.

Thus the neurologist believed that at best, though it may take months of rehabilitation, the patient can talk – though with a funny accent, walk – but with a limp that he even demonstrated, and maybe could even live independently later on. He definitely painted a more rosy picture than the gray picture that I have painted.

Hearing the neurologist’s opinion, it was obvious we have a “slight” difference of opinion. Perhaps slight was an understatement.

After considering the neurologist’s evaluation, the son and the family changed their mind and decided to defer calling hospice and instead support the patient as much as possible, including tube feedings and all.

To be honest, I was a bit perturbed that I gave such a bleak prognosis than what the other doctor gave. Have I given up on that patient too soon? Have I killed the embers of hope prematurely? Perhaps I have become so pessimistic in my view of things. Perhaps I have seen so many prolonged sufferings and bad outcomes despite our best intentions and efforts in my ICU experience. Perhaps I was just saving the family from the heartaches of clinging to unrealistic optimism. Or perhaps I become more cynical and have lost my faith in hope.

In my defense, maybe I just see the front end and the acute catastrophic courses of patients in the ICU, and have limited exposure to the success stories of patients’ wonderful recovery after prolonged and extensive rehabilitation.

But even though I felt betrayed by my negativism, I felt relieved that I have heard a differing opinion, and perhaps gave a chance to a life that we almost gave up on too soon. Even though I felt embarrassed and almost apologetic for my opinion, I was thankful that we gave hope a chance. Everybody deserves that chance.

The following day, when I rounded on our stroke patient, he was more obtunded and unresponsive. He now have labored breathing and had to be placed on a ventilator. I then requested a repeat CT scan of the head.

The CT scan showed what I was afraid would happen: a further extension of the stroke and more swelling, displacing the structures of the brain beyond the midline and even herniating down the brainstem. This was unquestionably a grave condition, and most likely fatal. No more differing opinions.

The family decided to transition to comfort cares, and the patient expired a day later.

I did not kill hope. It died.

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Constipated Teaching

Since I am practicing in a teaching hospital, besides treating patients, part of my duty is educating and training residents (doctors-in-training) and medical students. In fact the state university even gave me an academic title. My official title is: Adjunct Clinical Associate Professor. Adjunct, means extra or accessory. In other words, not that major. Maybe “A Junk” Professor is more appropriate. In my native language, saling-pusa.

Anyway, most of the time when I am seeing patients in the hospital, I am accompanied by medical residents or medical students. In the ICU though, my entourage could be quite large, composing of 2 to 3 residents, a medical student, a pharmacist, 1 to 2 pharmacy students, a respiratory therapist, and respiratory therapy students. Then when we round on a specific ICU patient, the nurse taking care of that patient will join our discussion too.

Having a group shadow me on my rounds has its perks, as many of the scut work the team could already accomplish in my behalf. Plus the bigger the entourage, the bigger the likelihood that people think you are important (not mere “a junk”), just don’t let that get into your head. But it has its disadvantages too. For one, I have to ask permission to break rounds, every time I needed to go to the restroom.

In our rounds, besides talking about the patients’ cases and our plan of treatment for each one of them, we also discuss about snippets of medical teachings, current trends of practice, new drugs and even latest research that support our plan of management. Thus I really needed to be updated on the most recent guidelines and studies.

Few weeks ago, as I was conducting my ICU rounds, we have been dealing with some very difficult cases as well as some unfortunate patients in our ICU whose chances of surviving were slim. As we went through consecutive depressing cases, I could sense the sadness and stress rubbing in into my team. I could feel the morale of the team was low, for taking care of these sad cases of patients.

As the captain of the team, besides making sure that the right management is given to each of our patient and assuring proper education and adequate training for my residents and students, I feel that it is my duty as well to keep a high spirit in my team.

One particular patient that we have was having a bad case of constipation that was made worse by his requirement for pain medications, on top of all his other life threatening conditions. We then discussed causes of constipation and its management in general. One complication of using opioid pain medication is constipation, as it can slow down the intestinal movement. So we decided to give our patient the relatively new injectable medicine for constipation that blocks the opioid receptors in the gastrointestinal tract without decreasing the pain relieving ability of the opioids.

Then I asked the team, “Have you heard of the long-awaited big study on constipation?”

They all looked at me shaking their heads as they have not heard of it, and anticipating more words of wisdom from me.

To this I said: “It has not come out yet.”

Realizing that I made a joke, and not to be outdone, our knowledgeable pharmacist chimed in, “But I heard of the recent study that said that diarrhea is hereditary.”

The team was smiling now, and seems to be in a better mood , waiting for the punchline.

The witty pharmacist concluded, “Because it runs in jeans (genes).” Eeeww!

With that we moved on into our next ICU patient.

*******

Pahabol na hugot: Constipation ka ba? Kasi I cannot get moving since you dumped me.

 

Weight on My Shoulder

Ever since I have chosen this career, I have this feeling of weight on my shoulder every time I am at work. There’s always something around my neck.

It’s not that I feel like Atlas, the Titan in Greek mythology who was condemned to hold up the sky for eternity. No, nothing like carrying the world on my shoulder.

I know this profession can be stressful. And in fact it is always in the top 10 of most stressful jobs in the world. Though it may not be as much stress as police officers, fire fighters, and enlisted military personnel.

On the other hand, at least our profession is handsomely compensated. I agree though that the salary for police officers, fire fighters and the military should be increased, for the services they provide and the risks they take just to perform their duties.

But this weight on my shoulder and this feeling of something hanging around my neck could be a badge of pride as well. A symbol of our profession if you will.

Come to think of it, there may be other ways to bear this, but this is the easiest way to carry this load. That is around our neck. Thus I would always carry this weight on my shoulder, perhaps until I change career or until I retire.

Like what the Beatles’ song say:

Boy, you gotta carry that weight,
Carry that weight a long time,
Boy, you gonna carry that weight,
Carry that weight a long time.

If you’re wondering what is this weight on my shoulder?

I am just pertaining to the stethoscope that I always carry around my neck when I am working.

Were you thinking of the load of responsibility that we are burdened with? Well, that too. Especially when we’re in charge of the ICU.

By the way a stethoscope only weighs 6 ounces, which is not even half a pound. Unlike the taho vendor in the Philippines who has to carry that enormous weight on their shoulders as they go through streets after streets, just to make a living.

I really have nothing to complain about.

 

The End Of A Miracle

(I am reposting an article from December 26, 2010, “My Christmas Calling.” I wrote it after being on-duty on Christmas day.)

Christmas morning. Freshly fallen snow was on the ground. It was a White Christmas after all.

Bah, humbug!

I forced myself to get up from bed. My throat was sore. It felt like somebody stuck a fork in my throat and scraped it raw. My body aches like I just ran a marathon. I caught a Christmas bug, you know. No, not the “joyful feeling” of the holidays. A real bug.

I don’t want to go to work, emotionally and physically. But I have to. I am on-duty for Christmas. Our patients in the hospital, especially in the ICU, needs my care. (But who will care for me?) On days like this, I just have to suck it in, take a couple (or make it a handful!) of Tylenol and will myself to go.

I left home with the kids still sleeping and the gifts under the tree unopened. Maybe I would be able to come home early and we can open the gifts together.

In the hospital I greeted people with perfunctory “Merry Christmas,” though I was not feeling the “merry” part. In fact was in a Scrooge-mood.

It was a busy day: 32 total hospitalized patients I rounded upon, 2 hospitals I went to, 19 ICU patients, 12 ventilator-dependent, 2 carbon monoxide poisoning that needed hyperbaric oxygen treatment, 1 chest tube insertion, 1 endotracheal intubation, 1 arterial catheter placement, 2 central venous catheter placement……. and a partridge in a pear tree.

As I dealt with the very critically ill patients and talked with their families, I knew that I was not the bearer of good tidings and joy, but rather of grim news most of the times. As the families broke down into tears and came to term to the gravity of the condition of their loved ones, I thought that these people were experiencing far worse Christmas than me. At least I am going home tonight. My patients will not. Some of them will not come home, ever. And for these families, Christmas will never be the same.

Slowly my “Grinchy” attitude peeled off and was replaced with a sympathetic spirit. I then realized my purpose for this holiday: that is to give my compassionate care for these unfortunate people, in this supposed to be joyful occasion.

The last patient I admitted to the ICU on Christmas came late afternoon. He was 32 years old. When he was 7, he received a life-giving gift, when he became a recipient of a heart transplant. His “miracle” heart had kept him alive for all these 25 years. However, for the past few years, his existence was less than joyful. Complications after complications have developed, and one by one his organs started failing. Including his borrowed heart.

Today he was brought to the Emergency Department barely alive. After transferring him to our ICU – placing him on a mechanical ventilator, putting tubes and catheters in his body, and flooding his system with medicines – his condition did not really improve much.

I spoke with her mother in the ICU’s waiting room. She quietly, but boldly stated, in between sobs, that she was ready to let go of her son who have suffered enough. She indicated to me that she just wanted his “boy” to go gently into the night.

Somehow, the ‘miracle’ heart will be resting this Christmas night.

Did the miracle ended?

I don’t think so. For the miracle of love persists. Love that is shown here by letting go. Letting go in some occasion, is more selfless than holding on.

There is another 7-year old boy who is waiting for his gift. That boy is my son waiting at home. He may be anxious to open his gifts. Or maybe he’s anxious just to see me come home.

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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.

A Somber Celebration

Last week, we had a patient in the ICU who was unwell. Unwell, is perhaps an understatement.

He was of an advanced age though, as he was in his 80’s, and maybe has already lived a full life. Yet he was still active, lives independently with his wife, and was in relatively good health, until he got sick and got admitted to the hospital.

He came down with a bad bout of pneumonia. So bad that he went into respiratory failure and had to be placed on mechanical ventilator. This was complicated as well, as he suffered a mild heart attack too. Furthermore, he also developed brisk bleeding in his stomach, but fortunately we were able to stop that bleeding, when we did the gastroscopy.

After several days of intensive support, surprisingly he got better. He got better enough that we were able to take him off the ventilator. He was going to pull through this. So we thought.

But less than 24 hours later, he was placed back on mechanical ventilator. His blood pressure dropped as results of overwhelming infection. He went into congestive heart failure. His kidneys also started to fail. His condition got worse than ever.

We sat down with the patient’s family and discussed with them the dire situation. They decided that they would like to continue the aggressive support and hang on for two more days. I thought it was kind of odd to have so specific timeline in their request.

Why two days?

Two days later, as we’re going through our morning rounds, I was told by my staff that we will be having a party later that day. A birthday celebration right there, in the ICU.

I learned that the family of our elderly patient have called all the family members that can come, to be there and visit the patient. They brought balloons and a large birthday cake. They even brought in the patient’s dog to the ICU! But of course they have to get a permit and confirm all the vaccination records of the dog.

I also learned that the family was planning to take him off life support that same day. They would like to transition to full comfort care, and let nature take its course.

The ICU staff got a birthday card that they passed around and asked us all to sign it. Honestly, I was stumped on what to write on the card.

Do I write “Happy Birthday,” knowing that it may not be really a happy event? Or do I write “May you have more birthdays to come,” which I know would not be true at all? Or should I write “Have a good last birthday?” But that sounds morbid! Or do I write “May you have peace on your birthday,” which I think is very appropriate, but it is as if I’m foretelling death before it actually happen?

Never did I have so much difficulty in writing a simple greeting on a birthday card before.

When the family were ready, we lightened the sedation and have the patient wake up, so he will at least have the chance to witness his own birthday celebration.

The ICU staff came and crowded inside his room and sang “Happy Birthday.” Though I guess, many of us we’re feeling rather sad than happy while singing that song.

We then extubated the patient and took him off the ventilator. He was able to speak after that, though very weakly. The family gave him a piece of his birthday cake which he tasted, even if it was just the frosting.

After a while, he started to show signs of discomfort. He was obviously struggling even just to take a breath. So after the final embraces from the family and a pat to his dog, we gave him medications to relax him and made him more comfortable. He slept the rest of his birthday celebration.

He later slept on into the eternal night.

********

P.S. I wrote on his birthday card, “May you have a meaningful birthday.”

 

Smoking Ban

I read in the news that President Duterte is planning to sign a law that will ban smoking in all public places nationwide. My response to this is that: it’s about time!

I don’t think in this day and age, that anybody in this world have not heard or read the damning facts that smoking is harmful to our health. As a lung specialist, and an advocate of no-smoking, I laud this plan to ban smoking in public places.

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I am a witness to all the grim and devastating effects of smoking. I see them everyday.

Though quite honestly, I partly owe it to the smokers, of why I have work today. But in the same token, I don’t want people to continue to smoke.

According to World Health Organization, lung cancer is the most common cancer worldwide. It is also the leading cause of all cancer deaths in the world, accounting to 1.37 million deaths annually. The number of deaths every year from lung cancer alone is more than the number of deaths from breast, colorectal and prostate cancer (other leading cancers) all combined.

In the Philippines, lung cancer is also the most common type of cancer, and is the leading cause of cancer deaths. And we have 17.3 million tobacco consumers, which makes the Philippines the number one in most number of smokers in Southeast Asia. I am not sure if we should be proud of being number one in that category.

More than 90% of lung cancers are linked to smoking. Other causes are occupational carcinogen exposure, radon and pollution. Though lung cancer can arise from people who never smoke, like the late Senator Miriam Santiago, but this is relatively rare.

Besides lung cancer, smoking also causes other diseases. COPD, heart disease, mouth and throat cancer, esophageal cancer, and vascular diseases to name a few.

I know there will be some that will complain and protest that this plan is unlawful. And surely some would say that this is unfair for the smokers. For definitely people should have the right of choice. Even the right to do stupid thing, like smoking.

But the ordinance is to ban smoking in public places only. This is not taking away your right to kill yourself by smoking. You are just not allowed to kill others too that can inhale your toxic fumes.

I remember my jeepney-riding days, where someone would be blowing cigarrette smoke in my face. So between the secondhand cigarrete smoke and the diesel fumes from the buses and jeepneys, no wonder I cannot breathe after sitting for some time in traffic.

Studies have shown that second hand smoke (exposure to others who are smoking) is almost as harmful as firsthand smoke. I pity the children who have parents who smoke in their presence. Where is their right for non-toxic air?

Several places in the world have already this smoking ban in public places being enforced for quite some time now. And I’m glad that the Philippines is catching up with the current times.

I am not denying the fact that it is very hard to quit smoking. There’s even reports that tobacco companies are making cigarrettes nowadays that have higher nicotine content, making it more addictive and making it more difficult to quit.

When I was doing my subspecialty training in Memorial Sloan Kettering Cancer Center in New York City, we have patients who were already dying of lung cancer but still cannot quit smoking. They would go outside the hospital building and smoke. This was almost two decades ago when smokers can still smoke in designated areas in the hospital grounds. I even saw a patient with tracheostomy (a hole in his throat) due to throat cancer, and he was smoking through his tracheostomy! How sad is that?

Nowadays, most hospitals have a total ban of smoking in their entire premises. In the hospital where I work now, smokers would go across the street from the hospital entrance and smoke there. Even when it’s in the middle of winter or even when snowing, where they are exposed to the elements, they would still go outside in the subfreezing temperature and smoke. Why? Because they cannot help it. How really sad is that?

So I get it, it’s hard to quit smoking. But I still support the smoking ban.

Even the cockroaches will be in favor of this.

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(*images from the internet)

 

 

Tortured Soul

She was a tortured soul.

In spite of all the medical interventions and having a supportive family, she still was always extremely depressed. It seems that she cannot get rid of her demons and the tormenting voices in her head. The desire to kill or hurt herself consumed her every day.

She has been on different anti-depressive medications and was regularly being followed by her psychiatrist. She even had several admissions to the inpatient psych unit. Yet nothing really alleviated her condition. For a person who is barely in her 30’s, she already had a fair share of misery.

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She has attempted suicide a number of times in the past. Though all of those times it was not serious, resulting no grave medical consequences. It was mostly cries for help.

But this time, it’s different.

Her family found her unresponsive in her room after presumably overdosing on a bunch of different pills. Emergency responders were called and upon their arrival, CPR was performed. They were able to establish a stable heart rhythm and patient was brought to the hospital where she was subsequently admitted to the ICU.

She laid there in our ICU, hooked to several monitors and life support. Her chest would rise and fall as the ventilator bellows air into her lungs.

Three days have passed since her admission, yet she remained unresponsive. In addition she had this intermittent jerking-like activity, which I believe was an ominous sign of severe anoxic brain injury. I called the neurologist to assist in her care.

Then few hours ago, something happened.

Her vital signs became more labile. The continuous EEG monitoring which the neurologist requested showed a significant change. The jerking-like activity have quit. Her pupils were now fixed and dilated.

My suspicion was that she now is brain-dead.

Brain death is a complete and irreversible loss of brain function. Unlike in a vegetative state which could have some autonomic or brain stem functions left, brain dead means cessation of all brain activity.

I updated her family of this recent development. Then I proceeded to do my confirmatory exam for brain death per protocol.

After my evaluation, I determined that all her neurologic functions were gone. I even performed an apnea test, which involves taking the patient off the ventilator for 8 full minutes, while providing oxygen through the endotracheal tube. If there was no respiratory motion for the entire time, and this is associated with an appropriate rise in the blood carbon dioxide level, then this is one verification that someone is indeed brain-dead.

The neurologist independently performed her evaluation as well, and also arrived at the same conclusion.

When one is declared brain-dead, it is an indicator of legal death. Different from a person who is in a continued vegetative state, who can be sustained on life support indefinitely (which is controversial in so many levels), a person who is declared brain-dead is officially dead. All life support should be discontinued. Even if the heart is still beating. No argument. No controversy.

I gathered the family and told them of my findings. They were obviously distraught, but accepted the news without any questions.

I also told them, that based on the patient’s driver’s license, she indicated that she was an organ donor. I asked the family if they would like to honor the patient’s wishes.

The family said, that they totally agree to donate the patient’s organs per her wishes. That despite of the patient’s several mistakes in her life, this may be the best decision she have ever made, according to them. And despite of her cloudy and troubled mind, she have decided on this selfless act.

I called the donor network.

I know that somewhere out there, another person will be set free from the shackles of dialysis as he or she would receive a long-awaited kidney. Another person will be given a new breath of life as he or she would receive a new set of lungs. And another person out there will be given a new lease of life, as he or she would receive a new heart.

All because of the gift of a tortured soul.

Long Beach, a Gala, and an Electromagnetic Lecture

Part of our big summer trip few weeks ago was going down to Long Beach, California. Long Beach is a city in Los Angeles County at the pacific coast of the US. It is 24 miles away from the city of Los Angeles, but that drive can take more than an hour due to terrible traffic.

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We went to Long Beach to attend my medical school’s sponsored event. It was the 24th University of Santo Tomas Medical Alumni Association of America (USTMAA) Grand Reunion and Medical Convention.

The Hilton Long Beach was the site of the event, and that’s where we stayed for a couple of days.

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Only a few blocks away from the hotel is the ocean and the Pine Avenue Pier. One early morning, I went out for my 2-3 miles run, and I wandered down to the pier (above and below photos were taken during my run).

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The Pier was lined with prime restaurants, so I guess you won’t get hungry if you stroll there.

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Here’s the marina with some of the boats docked there.

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There’s even a lighthouse at that Pier.

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Back to the USTMAAA event, since the event is billed as a Grand Reunion, many medical alumni from different batches attended. The oldest batch represented in the gala night was from medical class of 1951, though he was a lone attendee of his class. He was probably in his 90’s or nearing 90, yet he still looked strong and springy.

One of the biggest contingent was from the class of 1966, who were celebrating their 50th (Golden) anniversary. I tell you, those “old” folks can still dance the night away.

The “youngest” (the term ‘young’ is really relative) batch in that reunion was our class – from year 1991, which in my estimation was the biggest group represented. We were celebrating our 25th (Silver) anniversary.

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Above is a photo I grabbed from USTMAAA website, showing our batch during the parade of the different classes at the gala dinner. Though many of my other classmates who went to Long Beach did not attend the gala, but came for the other festivities and the medical conference.

To be honest, I am not really a fan of galas and pageantries, so that was not the main reason I attended. Sad to admit, I can’t even dance. Of course seeing my old friends and classmates was enough motivation to attend.

But the biggest reason I came was, I was invited to give one of the lectures during the medical convention, which I considered an honor and a privilege. Many of the lecturers, including the keynote speaker, was from my batch.

The theme of the conference was “Current and Interesting Topics in Medicine and Surgery.” Below is an ‘official’ photo (grabbed from USTMAAA website) of me giving the talk.

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The title of the lecture I gave was: The Lung and Winding Road (my apologies to the Beatles): Current Trends in Lung Cancer Screening and Diagnosis.

A portion of my talk was about Electromagnetic Navigational Bronchoscopy, a relatively new technology using GPS-like guidance with videogame-like images, when doing bronchoscopy and lung biopsy (see previous post about this topic).

Are you wondering what was the slide projected on the screen on the photo above?

Here is that specific slide on my presentation:

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For readers who are not familiar with the above character, this is Voltes V. He is an anime super robot, aired as a TV series in the Philippines in the 1970’s. One of his weapon was the “electromagnetic top.” We definitely are not the first ones to use the “electromagnetic” technology.

After the lecture, many attendees approached me and told me that they enjoyed my presentation very much. Maybe they were all Voltes V fans.

I had a fun time in Long Beach. I hope to be reunited with my classmates and other alumni in the next UST event. Borrowing the battle cry from the Voltes V team, “Let’s volt in!”

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P.S. Voltes V is now forever profiled in the USTMAAA website.

 

 

Debunking Folks’ Medical Advice: Part 5

Several weeks ago, I came down with a viral illness that derailed me for a couple of days. Yes, doctors get sick too. My wife gave me some tender loving care, including a foot massage, chest and back rub and herbal tea. This brought memories on how my mother and father cared for me when I was sick during my childhood days. Let’s examine if there’s some medical validity on these practices.

1. Baños or hot water bath for fever.

When I was young, whenever I would have a high fever, my mother would give me what she called baños (Spanish for bath). This involves having warm water in a small planggana (basin) and she would soak my feet in that basin, and with a small towel, wipe my neck, arms and legs with the hot water. The water was not scalding, though in my child’s mind it was boiling hot. She would though place another towel soaked in ice water on my head while she gives me the hot water sponge bath.

I was not a fan of that treatment, as I have seen her also pour hot water on dead chicken before she pluck out its feathers. And I am no chicken! Though I enjoyed the chicken in the tinola (a traditional Filipino dish) after it was cooked.

Several years later, after going through medical school and gaining more understanding, I realized that there’s science on this practice as the water bath can really bring down the fever. Though the water need not be very hot, just tepid temperature is enough. The evaporation of the water on the skin cools us and brings the temperature down. You can argue that using cold water will bring the fever much faster. However, cold water will cause more shivering and chills, and that will bring the core body temperature higher, so it will be counter productive. Thus tepid water is advisable.

How about the cold towel soaked in ice water in the head? That is to prevent the temperature in the head going even higher which can trigger fever convulsion, while having the hot bath.

My mom was right all along.

2. Salabat or ginger tea for sore throat.

You probably have been given salabat for sore throat before. Salabat has been known to be taken by singers or by people who use their voice a lot, when they are hoarse. Some suck the ginger itself to soothe their throat. Some people even believe that it can make their singing voice mellow.

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Ginger has been studied for its medical properties. It was found to have analgesic and anti-inflammatory effects. So there’s truth to this home-made remedy.

Ginger has also been used for cough, headaches, stomach ache, toothache and even joint pains. Some studies even suggest that ginger has anti-cancer properties. So go ahead and sip that salabat. It goes well with bibingka too (rice cake).

But the best use of ginger for me, is when it flavors the tinola!

3. Ampalaya (bitter melon) leaves’ extract for cough.

When we’re little and we have cough and thick phlegm, my father will get ampalaya leaves and pound it and get its extract. It was the most bitter substance I have tasted in my life! My father said that it would get the thick mucus out. Maybe it did, for I almost to the point of vomiting and coughing my lungs out after I took a teaspoonful of this bitter extract.

Ampalaya is being used for many disorders, including fever, cough, hemorrhoids, and stomach problems. There’s even studies showing benefits for diabetes, as it has insulin-like peptides that has properties to lower the blood sugar.

As far as its effect on the cough, I did not really find the exact mechanism of action of how it works. Maybe the bitterness caused my body to abhor it so much that I got better faster so I would not take those bitter extract again.

4. Warm kalamansi (calamondin) extract or juice for colds.

I remember my father or mother would squeeze 2 to 3 kalamansi into a spoon, then would give it to us to drink when we have the colds. That’s sure took away the colds as well as the smile on our face. Sometimes they will even heat the spoonful of kalamansi over the flame to make it hot before giving it to us. Or they would prepare kalamansi with warm water but no sugar for us to drink, which to me was more tolerable.

Kalamansi, as well as other citrus fruits, are rich in vitamin C. And we know that vitamin C is good for us, especially when we are fighting infection. So there is truth on this folk’s medical practice. Even today, doctors will advice people who have colds or flu to take lots of water as well as fruits rich in vitamin C to help fight off the sickness.

So taking a spoonful of squeezed kalamansi  when you have a cold? Go right ahead. But skip heating it up over a flame. Vitamin C is easily denatured or destroyed with heat.

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So there you have it people. These old folks’ remedy were effective after all. Who said you need an M.D. title to give sound medical advice?

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(*photos from the web)