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.

 

Pampalaglag

A post-Valentine’s story……

Sa isang maliit na barrio sa Pilipinas, isang babae ang nagpatingin sa duktor. Siya ay desperada.

“Doc, sana po ay matulungan ninyo ako. Wala po akong ibang mapupuntahan. Gusto ko pong magpalaglag,” ang halos na umiiyak na sambit ng babae.

Tinanong ng duktor ng ilang mga katanungan ang pasyente.

“Hija, ano ba ang iyong nararamdaman?”

“Kasi po lumalaki na ang aking tiyan, at para po itong laging humihilab,” sabi ng babae, “at lumalakas din po akong kumain.”

“May asawa ka ba,” ang tanong muli ng duktor.

“Wala po, pero mayroon po akong nobyo,” ang sagot ng babae.

“Anong sabi ng iyong nobyo tungkol sa problema mo,” and uling usisa ng butihing duktor.

“Hindi raw po muna siya makikipagkita sa akin, hangga’t hindi ko po raw nalulunasan ang problemang ito,” ang malungkot na dagdag ng babae.

“Ano naman ang payo ng iyong mga magulang,” ang tanong pa ng duktor.

“Ayaw ko pong malaman nila, at baka hindi po nila ako matanggap,” ang mahinang sagot ng kaawa-awang babae.

Marami pang naging tanong ang magaling na duktor, at sinagot naman ng babae ang lahat ng mga ito sa abot ng kanyang makakaya.

Matapos makuha ng duktor ang buong kuwento, ay kanya nang in-eksameng mabuti ang pasyente. Naging detalye at masinop ang duktor sa kanyang eksaminasyon.

Sumulat na ng reseta ang duktor at ito’y inabot sa kanyang pasyente.

“Hija, ito na ang mabisang gamot para sa iyo. Inumin mo ito ngayong gabi at bukas na bukas din, sigurado akong mawawala na ang iyong problema,” ang kumpidanteng sabi ng mabuting duktor.

Dali-daling nagtungo sa botika ang babae at binili ang niresetang gamot ng duktor.

Nang kinagabihan na, ay ininom ng babae ang resetang gamot sa kanya. Tatalab kaya ito? Malulunasan kaya ang kanyang problema? Ano kaya ang sasabihin ng kanyang mga magulang? Ano kaya ang magiging opinyon ng mga ibang tao? Makikipagbalikan na kaya sa kanya ang kanyang boyfriend?

Nang kinaumagahan na ay nakaramdam ng matinding sakit ng tiyan ang babae. Parang umiikot at gumigiling ang nasa sa loob na kanyang dala-dala. Butil-butil ang kanyang pawis at para baga siyang nanglalamig. Pakiramdam niya ay para siyang nakakain ng panis na pansit at kailangan niyang ilabas ang sama ng loob. Hindi na niya mapigilan.

Mabilis siyang tumakbo sa banyo. At sa kanyang pag-upo ay biglang lumuwal ang isang malaking kulapol ng patay na………..

Bulate!

Ang niresetang gamot? Combantrin.

(*Ang kathang isip na kwentong ito ay sanhi ng aking pagkalipas gutom.)

 

 

Who is Tiagong Tigas?

I was watching an NBA game on TV the other night, when a flash of insanity (or genius) hit me. And it’s not even a full moon.

I wondered if NBA basketball players would play for the Philippines, would they take on a more local-sounding name?

Back in my childhood days, during Toyota vs. Crispa rivalry, and during Robert Jaworski’s heyday, an American import played for Toyota. His name was Andrew Fields. However we joked around that his adopted Filipino (Tagalized) name was Andres Bukid. As you know, San Andres Bukid is a district in Manila.

So here’s my list of Filipinized names of current NBA players:

1. Tiagong Tigas – James Harden (Houston Rockets)

2. Juaning Pader – John Wall (Washington Wizards)

3. Dong Tampisaw – Dwayne Wade (Chicago Bulls)

4. Esteban Sabaw – Stephen Curry (Golden State Warriors)

5. Gurang Kaladkarin – Goran Dragic (Miami Heat)

6. Atincupung, Ging-ging – Antetokounmpo, Giannis (Milwaukee Bucks)

7. Kebong Pag-ibig – Kevin Love (Cleveland Cavaliers)

8. Jimeno Mayordomo – Jimmy Butler (Chicago Bulls)

9. Damong Luntian – Draymond Green (Golden State Warriors)

10. Tonying Pumarada – Tony Parker (San Antonio Spurs)

11. Kembot Lumakad – Kemba Walker (Charlotte Hornets)

12. Dekdek Bulaklak – Derrick Rose (NY Knicks)

13. Tiagong Biyak – Tiago Splitter (Atlanta Hawks)

14. Rodeng Bakla – Rudy Gay (Sacramento Kings)

15. Pablong Saksak – Paul Pierce (LA CLippers)

Can you think of anybody else? I like to hear from you.

NBA: Indiana Pacers at Houston Rockets

(*photo from the web)

Writings on the Wall

 

My head is light and the walls spinning,

Too much of the “happy hours” again,

Staggering down Manila’s dark alley,

My steps and dignity are both shaky.

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I know I have passed this way before,

Promising a change, I will go for,

But my will is weak to the intoxicating spirit,

I am but a spineless fool! Damn it!

 

My family have long gave up on me,

I’m at the point I’m giving up on me,

Am I beyond redemption? Can’t get free

From the quatro cantos that enslaves me.

 

Heeding the call, fumbling in the night,

I am desperate to seek the light,

Then the writings on the wall, I saw

It reads: Hoy, Bawal Umihi Dito!

 

(*dedicated to all who struggle with the bottle; photo from the web)

 

That’s Entertainment

I would say in advance that this post has nothing to do with the defunct youth-oriented variety TV show with that title, that was hosted by the late German Moreno, aired in the 80’s – 90’s.

But that’s entertainment!

No, not that show. I was pertaining to the current best entertainment in the Philippines.

Who could guess that this will be more fun that any TV show, tele-serye, or even kalye-serye? I can say that we Filipinos can only provide this level of showmanship.

There’s drama, action, and fiction – all rolled into one. Maybe next time they will add some musical as well. Oh I forgot, there’s already that. Remember, may “kumakanta,” di ba?

But before you surf crazy the entire TV channels searching for it, or go into expedition to the movie theaters or broadways, I was just alluding to the Philippine senate proceedings.

Best entertainment ever. And this is “real” life.

Witness: Pinagbabaril na po naming yung lalaki, pero buhay pa.

Senator: Ilan kayong  bumaril?

Witness: Marami po kami, nasa 30.

Senator: 30 kayong bumaril, pero buhay pa? Ano nga ulit pangalan ng pinagbabaril ninyo?

Witness: Si Neo po, your honor. (*Matrix movie soundtrack plays in the background*)

Ghost of FPJ interrupts: Pinuno mo na ang salop. Isang bala ka lang!

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I’m looking forward for more of this entertainment. Though I think it will become more fascinating, when the House will soon have their own “show.”

As our slogan says, “It’s more fun in the Philippines.”

I would like to end with a Filipino proverb:

Batobato sa langit, tamaan huwag magalit.

Or the new version:

Matobato sa langit, hindi matamaan kaya nagalit.

University by the Bay

My alma mater have seen renovation and updates in its structures and facilities over the years. After all, a more than 400-year-old establishment needs to keep up with the changes of time.

Earlier this year, when I revisted my school, I have noted some changes in the campus that were not present when I left its portals 25 years ago.

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If you enter the campus through the España entrance, the first structure that will welcome you is the Arch of the Century.  Somehow adding this low wall bearing the university’s name (photo above) at the side of the arch, gives this archaic landmark a fresh look.

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In front of the Main Building, which is arguably the most recognizable building on the campus, there is now the huge “UST” letters, as well as a growling tiger (above photo) prowling on the university’s grounds.

Even the plaza where the statue of Father Benavidez stands, got some modern framework around it giving it a contemporary look (photo below).

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I believe many of the makeover and updates in the campus were constructed right before the 400th year celebration 5 years ago.

Below is the landmark commemorating that event.

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Even the walkway that I passed everyday during my time in the university, has a different look. I don’t even remember that it was named Burgos Lane (photo below). I also like the “No Smoking” sign, which I hope is being followed and enforced.


Besides the changes inside the campus, there are also noticeable changes around and outside the campus. For sure the skyscrapers towering around the university campus were not there during my time.

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Then a couple of days ago, somebody posted a photo of my alma mater. I would say that this is the most ambitious and spectacular update to date that I have ever seen.

They added an ocean to the campus!

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Now it can claim to be called the University by the Bay.

*******

P.S. On a serious note, I pray for the safety of all who are affected by the heavy rains and flooding in the Philippines.

(*Photos I took and processed with an iPhone, except for the last picture which was taken by Michael Angelo Reyes and I grabbed from the internet.)

Country Drive

Last month when we were driving in Montana, we encountered something in the road that reminded me of the following story:

There was a city driver that wandered in the countryside, so the story goes.

As he was navigating the narrow winding road, an old beat up truck came around the bend where he was heading, and was driving towards him.

When the truck passed by him, the farmer rolled down his window and shouted, “Cow!”

The city driver felt insulted. How rude can this country driver be, and how dare him call him a cow!

So the city slicker angrily shouted back, “Pig!”

Feeling triumphant that he was able to retaliate at the “rude” farmer, the city driver approached the narrow bend, and made the sharp turn.

He then drove smack into a cow.

Back to our Montana drive, we indeed saw road signs warning of cows crossing. Luckily we did not crash into cows. But this is what actually stopped us.

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Not cows but horses! Horses with no riders.

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I did not honk my horn, nor revved my engine to scare them away. I just let them be and passed by them slowly.

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Have a good day horse! (*Who are you calling horse?*)

Breaking Wind

There was a story last week that broke like a wild-fire. Or more accurately it broke like a wild wind.

It was a story about a Swedish soccer player who was issued a red flag by the referee while he was playing in a football match. His offense? He “broke wind.” In simple terminology, he farted. The player, Adam Lindin Ljungkvist, claims that he had a “bad stomach” but was surprised and annoyed he was penalized for releasing bad air.

I know it may be inappropriate to fart in a public place nor it is prim and proper to do so in a polite company. But could it be an offense? Or a crime? Should we hold it in then?

There was a study not too long ago, published in New Zealand Medical Journal, that stated that you should not hold your fart in while in an airplane, but should “let it go.” No, the release of gas will not generate thrust nor help the buoyancy of the airplane. It has nothing to do with that. The issue is altitude can increase the gas content of the digestive system and it is not healthy to suppress the gas in.

Not healthy for the individual, you may say, but how about the health of the other passengers who would be exposed to the “polluted” air? Should gassy people be on the TSA’s No Fly list?

The authors of that particular study also suggest that airplane seat cushion should contain charcoal to help absorb and neutralize the smell. I would like this recommendation implemented.

What is the science behind fart? By the way, the term fart may not be decent to some, but it comes from the Old English “feortan” meaning “to break wind.”

Flatulence (that’s the medical term), is part of human living. We all fart. A normal person farts an average of more than 10 a day. Yes, women fart as often as men, they just may not be as proud of it. And for those who denies they fart, are either not telling the truth or not human.

Why do humans fart?

When we eat, drink or even when we clear our throat, we swallow tiny amounts of air which accumulates in our gut. When we digest the meal we ate, gas is also released from the breakdown of the food. As the gas builds up, the body may need to get rid of it. This we do by burping or by flatulence.

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air release

The chemical makeup of the average fart is: 59% nitrogen, 21% hydrogen, 9% carbon dioxide, 7% methane and 4% oxygen which are all odorless. The gas that gives it a distinctive smell is hydrogen sulfide (sulfur) which is less than 1% of this released gas.

Many times, flatulence occurs and the person is unaware of it – there is no smell, and the amount is tiny. If food has not been digested properly, it starts to decompose or rot, releasing sulfur. Which can make it stinkier.

Foods that can cause flatulence are generally those high in certain polysaccharides. Examples of these are: beans (of course you know that already!), sweet potatoes (kamote), broccoli, Brussel sprouts, cabbage, radishes, and cauliflowers. Though we should not particularly avoid these foods for they are healthy and very nutritious.

Other food products that may cause flatulence are artificial sweeteners (sorbitol and mannitol), carbonated drinks, and fiber supplements. Chewing gums can cause flatulence not because of its content, but because you swallow more air when you chew gum.

There are also health conditions that predispose to flatulence, like lactose intolerance, celiac disease (intolerance to gluten), and other more serious chronic conditions like Chron’s disease and ulcerative colitis.

Laxatives and antibiotics can also cause flatulence. Antibiotics do so by upsetting the normal intestinal bacterial flora.

How about the sound of a fart? That particular sound that we playfully simulate in a whoopee cushion, is not from the fart itself, but from the noise generated by the flapping of the butt cheeks as the wind passes through.

Apparently we are not the only civilization to appreciate the sounds of flatulence. Roman Emperor Elagabulus was known to trick his royal guests with a primitive version of the whoopee cushion.

What should you do when you “accidentally” broke wind while you’re in a crowd?

One, you can own up to it and ask for pardon, and explain that you had bean burrito for lunch. Most likely they’ll let it pass, for all of us pass gas. Or you can act as if nothing had happened and keep everybody guessing who’s the culprit. Or lastly you can act surprised but annoyed, then look suspiciously to someone beside you, and let others think it’s somebody else not you.

But what can you do if someone beside you farted? Should you run away?

According to a study by AsapScience, using the kinetic theory of gases, it figures that the smell particles of a fart can travel 243 meters per second, which is a lot faster than any human or animal can move. So sorry folks, you cannot outrun a fart!

Do you have more questions on this subject? The answer my friends may be blowing in the wind.

(*photo from the web)

 

 

 

Tatlong Kahilingan

Isang sawimpalad na binata ang nakatayo sa breakwater ng Maynila. Dahil lagi na lang siyang basted sa lahat ng kaniyang niligawang babae, kaya’t handa na itong tumalon sa maruming tubig ng Manila Bay at magpakalunod na lamang.

Ngunit bago ito magpakalunod ay mayroon siyang nakitang isang kakaibang bote na lumulutang-lutang sa tabi ng dagat. Kanyang pinulot ang bote at binuksan…..

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Poof!

Isang genie mula sa bote ang biglang lumitaw sa kanyang harapan!

“Maraming salamat kaibigan, at ako’y iyong pinalaya,” bati ng genie. “Bilang ganti, ay bibigyan kita ng tatlong kahilingan. Aking ipagkakaloob anuman ang iyong hilingin,” sabi pa ng genie.

Napaisip ang binata. Hmmm.

“Gusto kong maging mayaman,” ang naging unang hiling ng lalaki.

Poof!

Biglang nagkaroon ng Rolex na relo ang kanyang braso. Kinapa niya ang kanyang bulsa, at kanyang hinugot ang isang bagong Salvatore Ferragamo na wallet na busog na busog sa tig-iisang libong piso na pera.

Napalingon ang binata, at kanyang nakita ang isang kotse – isang pulang Porsche na nakaparada sa tabi ng breakwater na may vanity plate na “PEDRO,” na siyang pangalan ng binata.

Tuwang-tuwa ang kolokoy. Muli itong nag-isip.

“Gusto kong magkaroon ng magandang girlfriend,” ang naging pangalawang kahilingan ng binata.

Poof!

Nagkaroon ng mala-binibining Pilipinas na isang dalaga sa loob ng Porsche ni Pedro. Kumaway ito sa kanya. Nagpa-bebe wave naman ang binata sa magandang dilag at hanggang tenga ang ngiti ng kumag.

Muling napa-isip ang binata para sa kanyang pangatlong kahilingan. Ano kaya ang kanyang magiging huling hiling?

Naisip niya ang mga gwapong artista na tulad nila Dingdong Dantes at Alden Richards na pinagkakaguluhan ng mga kababaihan.

“Gusto ko kapag ako’y dumadaan, ako’y tinitilian ng mga kababaihan,” ang naging pangatlong hiling ng binata sa genie ng bote.

Poof!

At si Pedro ay naging isang gwapitong…….ipis!

*******

(*photo from the web)

(**Ang istoryang ito ay orihinal na kathang-isip ng isang utak na kulang sa tulog. Sige matutulog po muna ako.)