Question and Answer: Hindi Maubos na Ubo

May kanta ang Eraserheads na nagsasabi: “Hanggang sa dulo ng mundo, hanggang maubos ang ubo.” Pero ang tanong na tatalakayin natin ngayon ay ang hindi maubos na ubo.

Doc,

Good AM po. Ako po ay may ubo, matagal na po pero hindi pa rin naaalis. Akala ko dahil sa sumugod ako sa ulan kaya po ako inubo. Sumasakit na din po minsan ang aking likod pag ako umuubo, tas noong isang araw may bahid po ng dugo plema ko.

Hindi naman po ako nilalagngat. Sabi ng asawa ko pumapayat po raw ako, pero baka kulang daw ako sa bitamina. Ano pong dapat kong gawin? Sana po matulungan ninyo ako.

Toto

Dear Toto,

Maraming dahilan kung bakit tayo inuubo. Una sa lahat ang ubo ay hindi mismo sakit. Ito ay palatandaan o sintomas lamang na maaring tayo ay may sakit.

Ang ubo, ay isang reflex o protective response ng ating katawan sa isang bagay na maaring magdulot ng pinsala sa ating sistema. Tulad nang kapag ikaw ay nasamid, ibig sabihin, maaring may butil ng pagkain, o tubig, o laway o anumang foreign body ang nag-trespassing sa ating trachea or windpipe. Tayo ay uubo upang matangal ang anumang nakabara sa daluyan ng ating hangin.

May mga taong hindi makaubo o kaya’y mahina ang kanilang cough reflex, tulad ng mga na-stroke, o kaya’y mga nawalan ng malay, gaya nang sa sobrang kalasingan. Sila ay maaring mag-develop ng aspiration pneumonia. Ito ‘yung mga secretions mula sa kanilang bibig ay nakapuslit at naligaw papuntang baga. Dahil hindi sila makaubo ng maayos kaya nalulunod sila sa sarili nilang laway.

Umuubo rin tayo kung maraming plema sa ating daluyang ng hangin at baga. Ang ubo ay paraan upang maalis ang mga plema. Kaya’t hindi maganda kung atin laging pipigilan ang ubo. Kalimitan ang mga gamot na cough suppressants ay hindi kailangan, maliban kung talagang malala na ang ubo na para na tayong asong kumakahol at hindi na tayo makatulog.

the big yawn

Isa sa pinakamalimit na dahilan ng ubo ay infection. Dahil sa inflammation na sanhi ng infection, tumitindi ang mucus production sa ating daluyan ng hangin. Kadalasan ay virus ang sanhi nito, at wala masyadong mabisang gamot sa viral infection. Lilipas lang din naman ito. May mga medisina na maaring magpalabnaw ng plema, lalo na kung malagkit na parang kalamay, upang mas madali natin itong ilabas. Makakatulong din ang pag-inom ng maraming tubig.

Minsan ang infection ay dahil sa bacteria. Ito ang sanhi ng bacterial bronchitis o pneumonia. Dito maaring kailangan na natin ng antibiotics upang labanan ang infection. Pero minsan hindi lang bacteria, pero maaring fungal (amag) o mycobacteria (tulad ng tuberculosis o TB) ang sanhi ng infection. Sa pagkakataong ito, kailangan na talaga ng subaybay ng duktor para malunasan ang mga infection na ito.

May mga sanhi rin ng ubo na ang dahilan ay hindi infection. Tulad ng asthma, allergy, at gastroesophageal reflux disease (GERD). Sa asthma, maaring ang ubo ay katumbas ng bronchospasm o paninikip ng airways. Maari ring mamaga ang daluyan ng hangin dahil sa hika, kaya mayroon ding plema. Inhalers o tinaguriang bomba de hika ang makakapagbigay ginhawa dito.

Sa allergy naman, maaring maraming mucus o sipon galing sa ilong ang tumutulo sa lalamunan (post-nasal drip), at ito ay umiirita sa ating lalamunan. Maaring makatulong ang mga nose sprays at allergy medications.

Sa GERD naman, ang maaasim na asido mula sa stomach ay maaring umakyat papuntang lalamunan at ito ay umirita sa ating daluyan ng hangin. Makakatulong ang mga antacids na gamot para sa pesteng ahem na ito.

Isa pa sa mga dahilan ng ubo ay ang paninigarilyo. Nagrerebelde ang ating airways, at ang ating katawan ay naglalabas ng maraming mucus para protektahan ang sarili sa umaatakeng iritante. Ito ang sanhi ng tinatawag nating “smoker’s cough.” Siyempre maari rin magkaroon ng COPD or emphysema sa paninigarilyo, at hindi lang ubo ang sintomas nito, kundi kasama na pati ang paghingal at maingay na paghinga na parang nakalunok ng pusa.

Maari rin magkaroon ng kanser sa baga dahil sa paninigarilyo. Ang kanser ay isang sanhi ng ubong hindi maubos-ubos, hanggang maubos pati hininga. Sa katunayan, kapag kanser ang sanhi ng ubo, kalimitan ang kanser sa baga ay nasa advanced stage na. Sa ibang salita, mi ultimo ubo.

Balik ako sa kaso mo Toto, sabi mo medyo matagal na ang ubo mo. Ito ba’y ilang linggo na o ilang buwan na? Isa pa, ikaw ba ay naninigarilyo? Nababahala ako sa sabi mong may bahid ng dugo sa iyong plema. Maaring magkaroon ng dugo sa plema sanhi ng infection o iritasyon ng daluyan ng hangin. Pero maaring mas malala rin ang sanhi nito, tulad ng kanser.

Isa pa sa kinababahala ko ay sabi mo, pumapayat ka. Maaring dahil wala ka lang ganang kumain, o dahil na rin sa iyong sakit kaya nahuhulog ang iyong katawan.

Sa aking listahan ng maaring sanhi ng iyong ubo, infection ang isa sa aking hinala, kasama na rito ang TB, dahil medyo palasak pa rin ang TB sa Pilipinas. O kung ikaw ay naninigarilyo, dapat natin isaalang-alang na puwede itong kanser. Hindi sa tinatakot kita, ako’y nagaalala lamang.

Kaya ang payo ko sa iyo, magpatingin ka na sa iyong lokal na duktor kung hindi mo pa ginawa ito. Siguro kailangan mo na rin magpa-chest x-ray. Itigil mo na rin ang sigarilyo kung ikaw man ay naninigarilyo.

Buti pa kanta na lang tayo:

Hanggang sa dulo ng mundo,

Hanggang maubos ang ubo,

Hanggang gumulong ang luha,

Hanggang mahulog ang tala.

(*photo from the web)

 

Mi Ultimo Ubo

 

Hithit ubo, hithit ubo,

Pabili nga ng Marlboro,

Hithit ubo, hithit ubo,

Pahiram din ng posporo.

 

Hithit ubo, hithit ubo,

Butas na ang bulsa ko,

Hithit ubo, hithit ubo,

Butas na pati baga ko.

 

Hithit ubo, hithit ubo,

Hirap na hirap na ‘ko,

Hithit ubo, hithit ubo,

Tang’n@ng yosi ito!

 

Hithit ubo, hithit ubo,

Adios! Malupit na mundo,

Hingal ubo, hingal ubo,

Hingal……hingal……aaagghh.

smoking

(*image from the web)

I’m Free

I was on-call last weekend, and it was busy. The ICU was full. Our patients list was quite long. I only got about 8 hours of sleep from Friday to Sunday, that by the end of my 58 hours shift, I was really exhausted. I felt deflated and defeated.

Days like those, I even wonder, “Why am I doing this?”

After having Monday off, I came to the office the next morning and found this on my table:

IMG_1060

flowers and a memorial service program

The flowers came from a patient, or should I say from his relatives. My patient passed away. I should be the one sending flowers. But in this occasion, it was the dead and the grieving who gave the flowers.

I guess the family was just grateful and appreciative of the care I gave their loved one. Even if the end result was death.

Day like this, reaffirms why I am doing this.

I have taken care of this patient for almost 10 years. And over the years I saw his constant struggle to breathe, and his progressive decline. By the past year or so I have been seeing him so often in the clinic or in the hospital, that I have come to know him very well. Yet, despite our efforts he continued to get worse.

At the end I knew I have nothing left to offer him, and so we have agreed to place him under hospice care.

He had Chronic Obstructive Pulmonary Disease or COPD.

Damn cigarettes! If there’s any young people here reading this article and are smoking and feels that you’re indestructible, I am pleading to you, please stop smoking. I am a constant witness of the destructive effects of cigarettes and the utter suffering they cause. Whatever pleasure smoking gives, it is not worth it.

Though I would admit, some of the nicest people I came to know were smokers. And that includes my patient. They are just slaves of a bad habit that may not be their own doing.

In the funeral program of my patient that they also sent to me, was a poem by Ann Davidson, printed on it. A poem so apt for my patient. It was entitled “I’m Free.”

Free from the pain. Free from suffering. Free from the disease that tormented him. He was indeed free.

I’m Free

Don’t grieve for me, for now I’m free

I’m following the path God laid for me.

I took His hand when I heard Him call

I turned my back and left it all.

I could not stay another day

To laugh, to love, to work or play.

Tasks left undone must stay that way.

I’ve found that peace at the close of the day.

If my parting has left a void

Then fill it with remembered joy.

A friendship shared, a laugh, a kiss,

Ah, yes, these things I too will miss.

Be not burdened with times of sorrow

I wish you the sunshine of tomorrow,

My life’s been full, I’ve savored much

Good friends, good times, my loved one’s touch.

Perhaps my time seemed all too brief

Don’t lengthen it now with undue grief.

Lift up your heart and share with me.

God wanted me now; He set me free!

Life’s Worries

A couple of weeks ago, I took care of a patient who was admitted in the hospital for shortness of breath. She has COPD (CDOP if you’re obsessive-compulsive), a disease due to smoking, and went into acute respiratory failure.

The patient was really struggling to breathe thus the Emergency Room doctor placed her on a non-invasive positive pressure ventilator (NIPPV), a device similar to CPAP used by people with sleep apnea, to provide assistance in her respiration. She was then transferred to our ICU.

On the first day that I rounded on her she was still on the NIPPV and unable to talk much, as it was almost impossible to talk with that mask on, for it’s like having a blower in your face. I would not be able to hear her clearly anyway even if she wants to speak. Though I examined her thoroughly, I limited my history-taking to questions she can answer by yes or no.

The next day she was much better and we have weaned her off the NIPPV. She was sitting in a chair, breathing much easier and looking comfortable.

I pulled up a chair and sat beside her and talked. She admits she has been diagnosed with COPD for years, and has even been on oxygen at home. But sadly to say she continues to smoke. Damn cigarettes! I guess old habit never die.

I told her that it was vital that she quit smoking. Yet in the back of my mind, she has done quite good despite of her bad habits, for she was 84 years old after all, and she still lives independently, all by herself.

Then when I asked her how can I help her quit smoking, she relayed to me that she smoke because she was stressed out.

What? She was eighty-four years old and still stressed out? She should be relaxing and enjoying life, or whatever is left of it, at this age.

That was when she told me that she has not gotten over the death of her husband, whom she was married for sixty-one years. He died three years ago. I suppose the heartbreak never heals when you lose somebody you love and lived with, for that long.

If we only peel off our prejudgment and peer behind the puff of cigarette smoke, we will learn that these people are hurting inside.

Then she said that she was also worried about somebody she knew longer than her husband. She was worried about her mother.

Her mother? What?!!!

Wait a minute, was my patient confused? Too much medications maybe? Was she having ICU delirium? Or does she have the beginning of dementia perhaps?

But as I talked to her more, I ascertained that she was very lucid and of clear mind. She was indeed worried and stressed out about her mother, who has been in and out of the hospital for the past several months.

Her mother was 103 years old!

I came out of the ICU room with a smile. I was ever so determined to help my patient get well. And maybe if I can get her to relax and convince her to quit smoking, she will live more than 103.

IMG_2226

view from the hospital’s corridor

(photo taken with an iPhone)

Behind the Puff of Smoke

Marion was sitting in the examining table. He looked cachectic and debilitated. He was stooping forward, leaning on his arms like a tripod. His lips were pursed as he breath, and was using his neck muscles to assist his respiration. A small tank of oxygen was at the foot of the table and it was connected to a long tube and into a nasal cannula that was hooked to his nostrils. He was obviously struggling, but he managed to flash a smile when I entered the room.

I have known Marion for more than 5 years, and he went through a lot over the years. I have treated him for severe COPD (Chronic Obstructive Pulmonary Disease) and repeated exacerbation, lung mass, bouts of pneumonia, respiratory failure requiring mechanical ventilation, lung collapse requiring chest tubes, and multiple hospitalizations. He had gone weaker and weaker, and is wasting away with every labored breath. It is painful just to see him breathe. He was a heavy smoker, but had quit a few years ago, albeit a little too late. He is paying for all the years he had puffed away with those damning cigarettes.

I hate cigarettes! No, I have no personal vendetta against the tobacco companies. In fact, if there is a career that cigarettes made to flourish, it is mine. I partly owe my profession to cigarettes. Because of so many people who smoke, I have a lot of pulmonary patients, and that I can send my kids to college. And even if smoking will be banned starting today, we will still see the effects of smoking for many more years to come, that my practice will be secure until I retire. But I am witness to the tragic effects of smoking every single day, that it is plainly heartbreaking. I just wish people will stop smoking. Besides, there will be other lung patients aside from smokers, that I can survive with.

It is amazing that even with the known cold hard facts regarding the ill effects of tobacco, people still continue to smoke. And more astounding is the fact, that young people who are well-informed, still start and pick up the habit of smoking. I know it is hard to quit once you have formed the habit, but still it is difficult for me to fully understand why people would continue to smoke even if they are literally dying from it.

Many years ago,during my training in Memorial Sloan-Kettering Cancer Center, I have seen patients who have lost their voice box due to throat cancer, still smoking thru their tracheostomy tube, in front of the hospital, while they lean on their IV poles. I have even seen patients who had caught ablaze and suffered facial burns, as they tried to smoke with their oxygen on. I guess they wanted to go out blazing into the night.

Nowadays most of the hospitals have adopted a smoke-free campus. Nobody can smoke in the hospital grounds, so smokers have to get out of campus to lit-up. Here in Iowa, there is a state-wide ban in smoking in all public places, like restaurants and malls. The only public place that smoking is still allowed here, are in the casinos, but that may change soon too. For some reason smoking and gambling goes together. If you think about it, smoking is really gambling, with your own life at stake.

I strongly advise all my patients to quit smoking. We even provide support, counseling and prescription to help them quit. But still quite a number of them still do smoke and this get me really frustrated. Are they just a bunch of non-compliant morons?

Before I pass that judgement, I should distinguish my aversion between smoking and smokers. I should definitely abhor smoking, but not necessarily smokers. For it is ironic, that many of the good and kind people I come to know, are smokers. Behind that annoying puffs of cigarette smoke, is a person like you and me. A person who may be suffering, a person who needs help, and a person who needs love and understanding in spite of who they are.

After I examined Marion, he told me that I need to keep him going until June. I asked him what’s going on in June. “It will be my 50th wedding anniversary”, as he answered with a smile, “and I would not like to miss it for all the world.” I felt a lump in my throat. I know he is on borrowed time. But I prayed that his wish would be granted.

******

Post Note (4/14/12): Marion made it through his 50th wedding anniversary. He passed away a year after this article was posted.