Sakit sa Balakang, Sambong, at Badjao

Isa sa pinaka-mabentang artikulong inilathala ko sa blog na ito ay ang “Question and Answer: Sakit sa Balakang” (posted Sept 2016). Hanggang ngayon ay mahigit sa 100 tao kada araw pa rin ang sumisilip sa artikulong ito. Marami talaga yatang may masakit na balakang sa ating mga Pilipino. Bakit kaya?

Dahil marami pa rin ang nagtatanong tungkol sa sakit sa balakang, at dahil halos magkakatulad naman ang mga katanungan ay tumigil na po akong sagutin ito ng isa-isa. Pero naglathala naman ako ng aking pang-finale na sagot, “Sakit sa Balakang: Final Answer” (posted Aug 2018).

May natatanggap pa rin akong mga tanong sa sakit sa balakang hanggang sa ngayon, pero dedma na lang po ako. Pero noong nakaraang ilang linggo ay may nagtanong na hindi ko yata kayang palampasin lang, dahil maraming anggulo ito. Kaya’t heto na naman ako, sasagot muli sa isang katanungan.

Ito ang tanong ni Rowena (last name witheld).

Good day po.

Dati po bewang ang medyo masakit na parang ngalay sa akin ng mga nakakaraang araw. After ilang days sumakit po balakang ko sa bandang kaliwa lalo na pag nahakbang ang kaliwa kong paa. Nag pa-check up po ako at may UTI daw po ako. Niresetahan ako ng antibiotic at sambong. Pero kinagabihan lalo tumindi ang sakit.

At bago po nangyari ang lahat, meron po kasing nanghihingi ng limos na babaeng Badjao na may dalang bata. Hindi ko po s’ya nabigyan dahil wala akong barya. Para po siyang nagalit. Bago umalis tinapik po niya ako sa kaliwang bahagi ng balakang.

Nalilito na po ako at nahihirapan. Kaya po nag-search ako at baka may makatulong sa akin. Maraming salamat po.

Dear Rowena,

Sa iyong pagpapahayag ng iyong sintomas, sa aking tingin ay may kinalaman sa galugod (spine) ang dahilan ng iyong sakit sa balakang. Lalo na kapag gumagapang ang sakit sa hita at paa, at kung tumitindi ito kapag naglalakad. Maaring naiiipit ang ugat (nerve root) sa galugod kaya’t sumasakit at parang nangangalay.

Paki-basa na lang ng buo iyong artikulo kong Question and Answer: Sakit sa Balakang para sa mas kumpletong paliwanag at iba pang sanhi ng sakit sa balakang.

Kung ito ay UTI o kaya’y bato sa pantog o daanan ng ihi, maaring makaranas din ng matinding sakit, ngunit ang sakit ay hindi dapat gumagapang hanggang paa. Kung may iba pang gumagapang o nang-gagapang sa iyong hita, eh baka pulis na ang iyong kailangan.

Hindi ako pamilyar sa sambong, kaya’t ni-research ko pa kung ano ito. Ito ang aking napag-alaman tungkol sa sambong:

Ang sambong ay isang mabangong halaman. Ang scientific name nito ay “Blumea balsamifera” o “Blumea camphor.” Ito ay may medicinal properties. Isa rito ay ang diuretic effect – ito iyong nagdudulot ng pagpapaihi. Maari itong makatulong sa UTI o kaya para mailabas ang bato sa daanan ng ihi.

Dahil ang sambong ay mayroong methanolic compounds, ito ay nakakatulong din sa ubo at sipon. Ito rin ay may antibiotic properties dahil ito ay naglalaman ng cyptomeridiol at ichthyotherol acetate. Hindi naman siguro dahil sa sambong kaya’t lalong tumindi ang sakit ng iyong balakang, maliban na lang kung tumungga ka ng balde baldeng tsaa ng sambong ay maari itong makasikmura.

Tungkol naman sa mga Badjao, sila ay isa sa mga diskriminadong katutubong lahi ng tao. Sila ay kilala na “Gypsies of the Sea,” dahil sila ay nakatira sa mga kubo sa dalampasigan o kaya’y sa mga bangka na matatagpuan sa Sulu Sea. Ang kanilang kabuhayan ay ang pangingisda o pagsisid sa mga perlas.

Dahil sa digmaan, politikal na mga isyu, diskriminasyon, at komersyalisasyon ng pangingisda, sila ay natataboy sa kanilang tahanan sa karagatan. Marami sa kanila ay umaalis sa kanilang tradisyonal na lugar at nakikipagsapalaran sa mga barrio at lungsod.

Photo of a Badjao girl that went viral (image from Rappler)

Alam kong may mga Badjao na gumagala-gala sa mga siyudad at humihingi ng limos. Hindi ko alam kung ginagamit pa sila ng mga sindikato. Ngunit huwag naman po sana natin silang paratangan na mayroon silang dalang sumpa o kulam sa mga taong hindi sila napagbigyan, o mga taong hindi nila nagugustuhan.

Una sa lahat, hindi po ako naniniwala sa sumpa ng Badjao. Pangalawa, hindi na nga natin sila matulungan, napag-iisipan pa natin sila ng masama at inaakusahan na nais nila tayong saktan.

Rowena, alam kong naghahanap ka lang ng kasagutan sa iyong nararamdamang sakit, ngunit ako’y nakatitiyak na walang kinalaman ang pagtapik sa iyo ng Badjao. Pero kung sinabi mong hinambalos ka o tinadyakan ka ng Badjao, ay ibang usapan na iyon, at maaaring mo siyang paratangan na sanhi ng iyong sakit sa balakang.

Hanggang dito na lamang po muli, at salamat sa patuloy ninyong pagtangkilik.

Where Teddy Bear Dare Not Trod

A child’s Teddy Bear should not witness sad and painful experiences. Yet they do. Here’s a story for you.

I was working that weekend in the hospital for more than 24 hours already, mainly in the ICU, but still had a whole day to contend with. Then came Sunday morning, I was called to the Emergency Department (ED) for a CPR-in-progress. It was a woman in her 40’s who had a cardiac arrest. I was told she was still talking when she was brought by the ambulance. However she became unresponsive and her heart stopped few minutes upon arrival.

When I arrived at the resuscitation room of the ED, a team was furiously doing CPR on the patient, with the ED doctor directing the care. A Lucas device (a robotic contraption) was strapped on the patient’s chest doing the mechanical cardiac compression, while other personnel were hovering around the patient assisting in any way they can.

After about 30 minutes of CPR, which is already an eternity of CPR time, we still could not establish a stable cardiac rhythm. We probed the chest with an ultrasound while the Lucas device was temporarily paused, and it showed that there was no heart motion at all. In simple terms, the patient was dead.

But before we completely pronounce the patient dead, one of the team members suggested that we get the patient’s husband to the room so he can be present. So the CPR continued until the husband can be at the bedside. It is now acceptable to have family members in the room when CPR is in progress.

One study from France that was published in New England Journal of Medicine (a leading medical circulation) in 2013 showed that family members who watched CPR on their loved one have far less post traumatic stress disorder three months later. Similar later studies support this as well, stating that family presence can help ameliorate the pain of the death through the feeling of having helped support the patient during the passage from life to death and of having participated in this important moment.

When the husband came in to the resuscitation room, he was tugging along their son, who was clutching a Teddy Bear. The boy, I believe, was about 8-10 years old. The moment I saw the boy walked into the room, my heart sank. I felt that the boy should have been left outside and should have not witness this traumatic event. But it was too late.

Perhaps whoever spoke to them outside the room did not suggest that it was better for the boy to stay outside. Perhaps there was nobody who can stay with the boy outside the room. Perhaps it was the father’s decision to bring along the son to the room. Perhaps they have no idea of what they would witness. Or perhaps the father was not thinking clearly as he had more serious issues to grapple.

The boy was squirming while his father was holding him, and was shielding his eyes with his Teddy Bear. Finally he was able to escape from his dad’s grasp and he dashed out of the room with his bear. Was the scene too much for the boy or too much for the bear?

The father stayed in the room though until we finally stopped the CPR and pronounced the patient dead.

To lose a mother was already a tragedy. But to lose a mother at such a young age and witnessed it as she die was really heartbreaking.

Many of us feel that we should try to shield children from the painful facts of life. We believe that children should be all fun and play, sugar and spice, and everything nice. Yet for some kids, sooner or later, they have to deal with the ugly realities of this world.

I know Emergency Rooms are not for Teddy Bears. But I do not care about the bear. I care about the boy behind the bear. Besides the comfort from his cuddly companion, I pray that he finds lots of love and reassurance from the remaining family he has.

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(*photo from Pinterest)

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.

 

Lalamunang Butas

Bahagi ng pagiging isang masinop na duktor, ay ang pagkuha ng istorya, o aming tinatawag na history, mula sa pasyente. Dahil kalimitan, maaring ma-diagnose o malaman kung ano ang sakit sa pamamagitan lang ng history. Siyempre kailangan pa rin ng physical exam at mga ancillary testing, para makumpleto ang diagnosis. Pero napaka-importante ng history.

Kaya naman kasama sa aming training o pag-aaral bilang duktor, ay ang kung paano kumuha ng tamang history. Katulad nang kung masakit ang tiyan ng pasyente: aming itatanong kung kailan pa nagsimula, o anong oras ng araw lumilitaw ang sakit, anong klase ng sakit, anong maaring nagpapalubha o nagpapaginhawa sa sakit, kung saan mismo ang sakit, o kung ito ay gumagapang sa ibang bahagi ng katawan, kung kumain ba ng panis na pansit, at kung anu-ano pa.

Huwag ninyo sanang isipin na makulit lang ang inyong duktor dahil napakaraming tanong, na pati pagkain ninyo ng pansit ay inuusisa. Ang mga tanong na ito ay kailangan para malaman ang tamang diagnosis.

Oo nga’t mayroong mga pagkakataon na hindi kami makakuha ng tamang kuwento o history mula sa pasyente. Tulad ng mga pasyenteng tuliro o walang malay na dinala sa hospital. Marami kaming ganyang pasyente sa ICU. O kaya naman ay ibang wika o dialect ang kanilang salita, o kaya’y pipi ang pasyente, kaya’t kailangan pa namin ng interpreter.

Mayroon din namang mga pasyente na hindi makapagbigay ng tama o accurate na history, dahil lito sila, o talagang magulo lang silang kausap. Para silang laging lasing. Kaya naguguluhan tuloy pati ang duktor kung ano talaga ang nangyayari.

Saludo ako sa mga Pediatrician, na kayang malaman kung ano ang iniinda ng mga bata o sanggol nilang pasyente, kahit hindi pa ito nagsasalita. Siyempre nakakatulong din ang history na ibinibigay ng magulang ng mga bata.

Mas saludo ako sa mga Veterinarian, kung paano sila kumuha ng history. Siguro ay naiintindihan nila ang bawat kahol, meow, o huni ng kanilang pasyente. Buti na lang at hindi ako pinag-beterenaryo ng nanay ko, at baka kumakahol na rin ako ngayon.

Isang kuwento mula sa matagal na panahon nang nakalipas ang aking isasaysay sa inyo. Ito’y nangyari nang ako’y intern pa sa Pilipinas.  Isang araw ay sabik na sabik na nagkuwento sa amin ang isa naming co-intern, ng kanyang karanasan mula sa hospital ward.

Sabi niya, may pasyente raw siyang may butas sa lalamunan o tracheostomy. Siguro dahil sa cancer sa larynx, pero hindi niya ito sigurado.  Kaya’t kailangan pa rin niyang kunin ang history ng pasyente.

Kung hindi ninyo alam kung paano ang may tracheostomy, sila ay hindi makapagsalita ng maayos,  dahil lumalabas ang hangin sa kanilang tracheostomy at hindi dumadaan sa vocal cord. Minsan, yung mga may tracheostomy, ay wala na ring vocal cord, at tuluyan na silang hindi makapagsalita.

Gayun pa man, desidido pa rin ang aking co-intern na kunin ang history ng kanyang pasyente.

Intern: Kuya, ano po bang dahilan bakit ka pumunta sa ospital?

Pasyente: Heh, hasi hirahp ahoh humingah.

Intern: Ganoon ba? Eh bakit ka nagka-tracheostomy?

Pasyente: Heh hasi, hanito hiyan. Halahas haho hahihahiho. Hayah haghahooh haho hang hanser sa lahlahmunah.

Intern: Teka, teka kuya. Hindi po kita maintindihan.

Luminga-linga ang aking co-intern at nagbakasakali na may kasama o bantay ang kanyang pasyente. Inisip niya, baka makakatulong ito na magbigay ng kuwento.

Sapak naman at naroon sa may pintuan ang isang kabataang lalaki. Tinanong ng intern kung kilala ba niya o siya ba ang bantay ng pasyente.

Tumango naman ang lalaki. Natuwa ang intern.

Tinanong uli ng intern kung alam ng bantay ang kwento ng pasyente. Tumango ulit ang bantay. Lalong natuwa ang intern.

Intern: Ano ba ang nangyari sa kanya?

Bantay: Ngabi ngiya, malangas naw ngiya mangingangiyo, ngaya ngagngaroon ngiya ngang nganser nga lalamungan.

Toink!

Sa kabila nito, nakuha pa rin ng intern ang wastong history. Kinailangan lang ng konting tiyaga at pangunawa.

*********

(*Ang kuwentong ito ay tunay na pangyayari, at hindi ko po intensiyon na laitin ang may mga tracheostomy o cleft palate.)

 

Pahabol na tula:

Mga lalamunang butas,

At ngala-ngalang bukas,

Mga boses na gasgas,

Hirap silang bumigkas.

H’wag batuhin ng pintas,

Bagkus tratuhin ng patas,

‘Pagkat ‘di man sila matatas,

Isip nila’y matalas.

Huwag Kang Puputok

Siguro lahat tayo ay may kakilalang tao na malakas magpaputok. Hindi rebentador o kaya baril ang ibig kong sabihin. Ang tinutukoy kong putok ay iyong nakakainis na amoy mula sa katawan. Sa ibang salita, body odor o B.O.

Kung ikaw ang may putok, sana makatulong sa iyo ang artikulong ito.

Isang senaryo sa Pilipinas: nasa loob ka ng jeepney.  Dahil sa sobrang init at trapik ay tumatagaktak ang pawis ng lahat. Tapos, may mamang sumakay at sumiksik sa tabi mo. Pag-arangkada ng jeep, itinaas ng mama yung kanyang braso para humawak. Sakto naman yung kanyang kili-kili sa mukha mo. Pag-hinga mo, boom! Parang gusto mo nang tumalon sa jeep, o kaya’y ilawit ang iyong ulo sa labas at pipiliin mo pang suminghot ng maiitim na usok ng jeep at bus, kesa mamatay sa putok ng katabi mo. Naka-relate ka ba?

Ano ba ang sanhi ng putok?

Ang medical term sa putok o anghit, ay bromhidrosis. Ito at ang masangsang na amoy dahil sa pawis. Ang pawis ay mula sa sweat glands. Maaring tanungin mo, bakit ba ginawa ng Diyos ang sweat glands kung ang magiging sanhi lang nito ay anghit?

Ang sweat glands ay importante sa kalusugan at mismong buhay ng tao. Ito ay para sa thermoregulation ng ating katawan. Kung hindi tayo papawisan tayo ay mag-o-overheat at maaring mamatay, parang makina ng kotse na kailangan ng tubig sa radiator para hindi pumalya. Kaya’t sa ayaw mo man o gusto, hindi lang si Andres Bonifacio, kundi tayong lahat ay anak-pawis.

Isang klase ng sweat glands ay ang apocrine glands. Maraming apocrine glands sa axillary area (kili-kili) at pubic area. Maliban sa pagse-secrete ng pawis, ito ay nagse-secrete din ng hormone, na ang tawag ay pheromones. Ito ay may kakaibang amoy. Ang pheromones ang siyang naamoy ng mga hayop, para ma-attrack sa kanilang ka-partner. Ito ang dahilan kung kaya kahit sa malayo ay nakakaakit ang paru-paro, baboy-damo, o aso ng kanilang kalaguyo.

Pagnagbinata at nagdalaga na ang tao, dumadami ang apocrine glands at secretion nito. Pero sa ating tao, hindi gaya sa hayop, hindi masyadong kailangan ang pheromones upang humanap ng ka-partner. Kasi may on-line dating site na (aha-ha). Isa pa, mas mabisa siguro ang bulaklak at chocolates kesa pheromones para sa tao.

Balik natin ang usapan sa pawis. Sa katanuyan ang pawis ay walang amoy. Ngunit kapag may mga bacteria sa ating katawan, na nagre-react sa ating pawis o hormone na galing sa ating sweat glands, lalo na sa apocrine glands, sa halip na walang amoy, nagkakaroon ng mababantot na mga chemical. Mga chemical tulad ng ammoniaE-3-methyl-2-hexanoic acid at 3-hydroxy-3-methyl-heaxnoic acid, (konting chemistry lesson lang po). Ito ang isang sanhi ng putok.

Minsan ang ating diet, gamot, mga toxins, metabolic disorders, at ibang sakit, tulad ng liver at kidney failure, ay nagdudulot rin o nagpapalala ng mabahong amoy ng ating katawan.

Ang bromhidrosis ay maaring makaapekto sa kalusugan. At sa kalusugan din ng ibang kawawang taong makakaamoy. Pero maliban sa pisikal na kalusugan, ang taong may bromhidrosis ay maari ring magdusa ng social isolation at low self-esteem. Sino nga bang gustong mag-hang-out sa taong may putok?

Anong dapat gawin, o ano ang mga lunas sa isang taong may bromhidrosis?

1. Maligo ng regular.

Malaki ang nagagawa ng personal hygiene sa putok. Dahil may kinalaman ang bacteria sa masangsang na amoy, mababawasan ang bacteria sa katawan kung maliligo ka nang regular. Hindi ko sinasabing maligo ka nang apat na beses isang araw, pero sikapin kahit minsan sa isang araw. Maari ring makatulong ang pag-gamit ng anti-bacterial soap.

2. Gumamit ng anti-perspirant at deodorant.

Ang anti-perspirant ay nagpapabawas sa pagpapapawis. Ang common ingredient ng mga antiperspirant ay aluminum salt. Ang “tawas” na popular na ginagamit para sa anghit ay hydrated aluminum potassium sulfate, at ito’y mabisang anti-perspirant. Ang deodorant naman ay mga pabangong nagkukubli sa mabahong amoy. Marami sa mga produkto ngayon ay magkasama na ang anti-perspirant at deodorant.

tawas

Kryptonite? No, Tawas Crystal!

3. Hair removal

Dahil ang buhok ay maaring mag-trap sa bacteria, maaring makatulong ang pag-aahit ng buhok sa kili-kili. Kaya pwedeng slogan: May anghit? Mag-ahit!

4. Palitan kaagad ang damit na pinagpawisan.

Panatilihing tuyo ang katawan. Hindi sa dahil ikaw ay mapupulmonya kung matuyo ang pawis. Pero mababawasan ang mabahong amoy-pawis kung huhubarin mo kaagad ang basang damit na pinagpawisan mo. Isa pa, gusto ng bacteria ang mabasa-basang environment.

5. Iwasan ang mga pagkaing may maaamoy na spices.

Siguro naobserbahan mo na rin na may mga pagkaing amoy kili-kili. Hindi ko ikinakaila na masarap ang mga ito. Subalit kung amoy kambing ka na, bawasan mo na siguro ang mga maaamoy na spices tulad ng curry, cumin, sibuyas at bawang. Pero pwedeng rason na OK lang mag-amoy bawang, kasi at least walang aaswang sa iyo.

6. Huwag manigarilyo.

Hindi sa nagpapabawas ng pawis ang hindi paninigarilyo. Pero ang sigarilyo ay isang sanhi ng mabahong amoy. At mabahong hininga. May B.O. ka na nga, may bad breath ka pa, eh kawawa ka nang talaga.

7. Removal of apocrine glands.

Sa malalang bromhidrosis, ay maaring i-offer ng mga duktor ang pagtanggal ng apocrine glands. Maari itong tanggalin sa pamamagitan ng surgical excision, liposuction, o laser therapy. Hindi dahil nabasa mo rito ang laser therapy, huwag mo sanang tangkaing na sunugin ang iyong kili-kili. Please consult your doctor.

Hanggang dito na lang at sana ay may natutunan kayo. At tandaan, hindi lang sa Bagong Taon po bawal magpaputok!

(*photo of tawas from the web)

Barriers

He was always there.

Constantly standing outside the ICU room, that is closed by a sliding glass door. He looked worried. The expression on his face was if he was begging for any news or information to any hospital staff that goes in and out of that room. Except that even when we tried to talk to him, he does not comprehend any word we say.

He does not speak English. Yet I believe he had a sense of what was going on. I think he somehow knew that something very bad was going on. Except nobody can really confirm it to him in a language he can understand.

His wife was inside that ICU glass room. Lying in bed hooked to several monitors and to a life-sustaining machine. Infusing into her veins were several liquid medications in upside down bottles hanging from poles. Coming out of her body were several tubes and catheters – some in natural body orifices, and some in surgically made openings.

The room was a negative air-pressure isolation room. Meaning, that all air droplets were being suck out of that room to a special outlet to prevent from spreading. And all personnel that go into that room needs to don a gown, a mask or a respiratory hood, and gloves.

As he stands outside that glass room looking in, several barriers are separating him from his sick wife, and from the world.

First is the physical barrier of being in an isolation room. This is being done as we suspect she has a highly contagious disease that can spread not just to the other hospital patients, but also to the hospital staff. If only he can be constantly at her bedside. Of course he is free to go inside the room, as long as he wear all those protective gear.

Second is the language barrier. Being a new immigrant to this country and not understanding its language can be very isolating. Not able to communicate even the simplest of questions is already difficult, how much more understanding a very complex situation.

Perhaps he and his wife came to this country to escape hardship or persecution. Perhaps they came here to pursue a dream and to begin a new life. Then, this happened. Which leads me to the biggest barrier of all, the barrier of the unknown tomorrow. What will happen to his wife? To him? To their dreams? And their future?

For the past two days we have been talking to him only through a phone interpreter. Due to the circumstances’ limitation, most of the conversation with him was to explain a procedure or a test that is needed, and to obtain his consent. Consent for blood transfusion. Consent for the CT scan and MRI. For the spinal tap. For chest tube insertion. For percutaneous abdominal drainage catheter. For bronchoscopy. And other more. But sitting down and explaining to him every nitty-gritty details of his wife’s illness and its prognosis, we have not done yet.

Finally, the social worker was able to get an interpreter to come to the hospital. Being an obscure dialect of a certain language, it was hard to get an interpreter in person.

So I sat down with him, and with a live interpreter, explained in as much as I could, the gloomy situation. I explained to him the severity of his wife’s condition: with overwhelming still-to-be-determined infection, plus the ravaging systemic lupus affecting almost every organ including the brain, the odds were plainly against us.

As I converse with him through the interpreter, I learned that he has no relatives and the only family he had here in the US is his wife. I also learned that at night he still goes to work at a meat-packing factory so he can keep his job, and then come and stay in the hospital all day. Somehow he just tries to sneak some naps in the ICU waiting room during the day. No wonder he looked so haggard. Life can be tough at times.

Then he asked me the crucial question, “Would my wife get better?”

I gave him my honest answer, “I don’t know.” I told him that there’s a possibility that his wife may die. Even though she’s only 22 years old.

His face became more saddened. Perhaps that’s an information that he was afraid to learn. Now through the interpreter, he fully grasps the gravity of the state she’s in. Sometimes I think, that not knowing is better. Perhaps not understanding, is bliss.

Two more days passed, and he was there most of the time. Outside the glass door. Looking. Pleading. Hoping. I almost wanted to avoid him, for there’s no comforting words I can say, with or without the interpreter.

But today is different. I cannot wait for the interpreter to arrive so I can talk to him. I needed to tell him the news. I think we have found an answer. I think she is slowly getting better.

I needed to tell him, that I believe she will live.

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(*photo taken with an iPhone)

Question and Answer: Sakit sa Balakang (2)

I have been asked diverse questions on this blog, from how much is a kilo of chicken liver, or where to get anting-anting, to how to counter a kulam. But there are some medical questions as well.

A certain Adrian, asked me a question regarding his condition, and I would like to answer him through this post. I hope the information here would help him and others who may have a similar problem.

Hi Doc,

May ilang buwan na din po nasakit yung right side ng balakang ko pati po yung kanang binti ko. Ngayon nararamdaman ko parang lumalala na kase diko na mapaliwanag yung sakit, masakit na nangangalay. Nung una po nangangalay lang yung right leg ko kaya binalewala ko lang, sinisipa-sipa ko lang hanggang sa tumagal nararamdaman ko na lumalala na. Hindi na ko makatayo ng matagal kase nangangalay yung binti ko at sumasakit din hanggang sa pag upo yung balakang at binti ko sabay sumasakit na parang na-ngilo 😑.

Pati sa pag higa nangangalay pa din kaya palagi ako nakatagilid, hanggang sa pag gising at pag bangon ko doc masakit. Hindi ko na kaya iunat yung dalawang binti ko kase sumasakit ng sobra yung likod ko dun sa gitnang part ng balakang. Pati pag yuko masakit parang konektado sa buto pababa ng binti yung sakit kapag nayuko ako 😢.

Doc may simtomas ako ng scoliosis. Dahil po ba dun yon kaya sumasakit yung balakang at binti ko?

Nagpa check-up na po kame sa doctor. Nag pakuha na po ko ng ihi at dugo at wala naman nakita. Niresitahan lang ako ng gamot tapos nag pa x-ray ako. Hindi naman ganun kalala yung scoliosis ko pero napansin ko na hindi na pantay yung balakang ko, doc mejo mataas yung right side. Patulong naman doc 😞.

Salamat po.

Salamat Adrian sa iyong tanong. Dahil medyo extensive and pagkaka-describe mo ng mga sintomas mo, kaya may idea ako kung anong nangyayari sa iyo. Siyempre iba pa rin yung tunay na harap-harapang pag-tingin at pag-examen sa iyo ng duktor.

Una sa lahat ang tungkol sa scoliosis. Scoliosis is defined as lateral curvature of the spine. Maraming maaaring sanhi ng scoliosis, tulad ng neuromuscular disease (tulad ng polio), vertebral disease (tulad ng osteoporosis, tuberculosis of the spine, Rickets), disorder of connective tissue (gaya ng mga genetic disorder na Marfan’s syndrome at Ehler Danlos syndrome), at iba pa.

Kadalasan ang pinakaapektado ng scoliosis ay ang thoraco-lumbar area. Kung malala talaga ang curvature ng scoliosis, maaring maapektuhan ang mga chest organs tulad ng baga at puso, dahil unti-unti silang naiipit o nasasakal. Maari ring maapektuhan ang mga muscles ng braso at hita at ito’y humihina.

Ang evaluation ng scoliosis ay sinusukat kung gaano kalala yung angle ng curvature. Kung hindi naman masyadong malala, ay pwedeng conservative management lang, tulad ng mga strengthening exercises and therapy sa spine o kaya ay paglalagay ng brace.

Kung talagang malala naman ang curvature, ay maaring lagyan ng bakal (rods) ang spine para ito dumiretso. Payo ko lang, huwag lang sa magbabakal o sa talyer kayo magpalagay ng bakal sa likod, kung hindi sa kwalipikadong orthopedic surgeon.

Adrian, hindi ko matiyak kung ang nararamdaman mo ay sanhi ng iyong scoliosis. Pero sa pagkaka-describe mo, ang aking hinala ay lumbosacral radiculopathy ang iniinda mo. Ibig sabihin, parang naiipit na yung ugat (nerve root) sa may vertebrae mo sa lumbosacral area, kaya’t parang nangangalay, sumasakit, at nanghihina ang iyong likod, balakang at mga binti.

Ang mga pinakamadalas na sanhi ng lumbosacral radiculopathy ay vertebral disc herniation (disc bulging out causing nerve root compression) at spondylosis (narrowing of the intraspinal canal due to degenerative arthritis). Mga iba pang sanhi ng lumbosacral radiculopathy ay infection, inflammation, neoplasm (tumors), at vascular disease.

Ang pinaka-magandang evaluation kung hinihinalang may lumbosacral radiculopathy ay CT scan o kaya MRI of the spine. Ang simpleng x-ray lang ay maaring hindi sapat na evaluation.

Hindi naman lahat ng sanhi ng lumbosacral radiculopathy ay kinakailangan ng surgery. Minsan pwedeng gamot lang gaya ng anti-inflammatory agents, o exercises, o physcial therapy ay uubra na. Baka makatulong kahit si Mang Kepweng.

Pero rinirikumenda ko pa rin na mag-follow-up ka sa iyong lokal na duktor, at kung kinakailangan kang i-refer sa espesyalistang nararapat, ay ito ang pinakamabuting gawin mo.

Adrian, sana ay nakatulong ito sa iyo. At paki-padala na lang yung dalawang hopiang munggo na bayad ko. Salamat po.

Frankenstein Medicine

For this week, I have been spending 8-9 hours a day inside the classroom and in the simulation laboratory trying to learn something new. Never too late to learn a new trick, even for an old dog. Though I admit I was almost half asleep in some of the lectures.

The hospital where I have affiliation with, will have a “new” intervention available as soon as next month. This treatment is called Extracorporeal Life Support (ECLS) or also known as Extracorporeal Membrane Oxygenation (ECMO). So they are training us doctors (critical care specialists, cardiologists and thoracic surgeons), as well as nurses, respiratory therapists and perfusionists, so we can have this life support system off and running.

In a simplistic way, ECLS entails placing large tubes to suck out the blood from the patient. Then having the blood run into a machine where it will be bathed with oxygen and then pumped back into the body. ‘Extra’ means outside, and ‘corporeal’ means relating to body, thus out-of-body life support.

Does this mean the patient will have out-of-body experience?

For patients, whether kids or adults, whose organs have failed for one reason or another, especially the heart or the lungs, can be placed on this life support system to sustain them and keep them alive and buy some time. The use of this intervention is not by all means the first line of treatment but rather of a last-ditch salvo. But it definitely has saved lives, and more and more advanced centers are offering it. Our hospital will be one of the first to provide it in our state.

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baby on ECLS (photo from the net)

ECLS is not really a new procedure. This has been done for several decades now. Except before, the intervention is only limited to short period of time, like several hours only. The main use of this before was in the operating room during cardiac surgery. They run the blood out of the patient’s body and through this machine, while the surgeon stop the beating heart and tinker on it. I can imagine the heart surgeon singing Sting’s “Be still my beating heart” while he operates. Then the machine is shut off once the heart is beating again.

Now ECLS is also being used outside the operating room, and people are placed on this life support while in the Intensive Care Unit. They can be on this for a few days, a few weeks, or sometimes even months – while their own body and organs recover, or while they wait for a new heart or a new lung, or both, or until “kingdom come.”

Of course the complexity of this intervention is beyond what I can explain here, not to mention the immense cost to the already burdened health care system and the sensitive ethical questions involve, like who to place or who not to place, or when to continue and when to stop. Are we playing God?

While we are doing the training, one of the trainee commented with a sinister smile, “we are Dr. Frankenstein.”

Is this as close as we get to Frankenstein medicine? I don’t think so. We have not created a monster. Yet.

 

Daddy is Home

It was a long day.

In reality, it had been a series of long days, and long weeks, of a long month. You see, I have been the ICU attending physician for the past 4 weeks, and the stress of work and taking care of very sick patients was like a dragon breathing down my neck. It was wearing me down.

I came home feeling depleted and defeated.

Even though it was late, my wife and kids were just happy to see me home. My wife has even waited for me to eat dinner, though I knew she was tired and hungry too. It felt good to be home after such an arduous day.

Before we went to bed, we had a family prayer, just like every night. My son led the prayer, and I heard him say, “Thank you God, for bringing Daddy home.”

Suddenly, all the day’s cares melted away. I felt so blessed.

As I rest my head on the pillow, I thought of the other fathers in the world that were not able to come home. The overseas contract workers. The soldiers deployed somewhere away from their home. And the others for some reason or another that cannot come home tonight. Including our patients that were languishing in the ICU. I felt sad for them and their kids who cannot say the prayer of thanks that my son did.

I especially thought of the father I took care earlier today. He will not come home. Ever.

May he rest in peace. And I pray that his family find peace.

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waiting for daddy

(*photo from here)

When Doctors Cry

It’s alright Melissa. You can dry your tears now. This is just part of the job we do. I know, textbooks and medical school did not prepare you for situation like this.

Melissa* is our young medical resident (doctor-in-training) who was on-call that night in the ICU. I received a call from her a little past midnight for an admission, who was doing poorly. So I had to go back to the hospital.

Our new patient was a 19 year-old kid. Yeah, I consider that age a kid. He was brought to the Emergency Room (ER) after he complained of unable to breathe, then collapsed, and became unresponsive.

When the ambulance arrived, he was not breathing and had no pulse. They did CPR (cardiopulmonary resuscitation) and worked on him for almost 30 minutes before a heart rhythm was re-established. Thirty minutes are an eternity to have no heart beat.

In the ER, he was treated for cardiorespiratory failure, thought to be from severe asthma attack. He was hooked to a ventilator and started on medications for asthma. He was subsequently admitted to our ICU.

After the patient was transferred to my care in the ICU, I thought that the story does not make sense, though asthma can be very severe at times. Plus, the heart shadow on the chest x-ray appeared to be huge in my opinion. So I asked my resident to get a CT scan to rule out a blood clot in the lungs or other pathology.

The result of the CT scan caught us by surprise. It showed a big tumor in the middle of the chest, compressing the heart and the main airways. No wonder, our patient cannot breathe. Furthermore, he had extensive “free air” in the abdomen, signifying that he had a ruptured bowel. What caused it? I could only speculate.

The situation had turned from serious to grim.

When I examined the patient, I noted that aside from being comatose, his pupils were fixed and dilated. He did not respond to any stimuli at all, but was having “seizure-like” movement. That was an ominous sign. It was indicative of irreversible severe brain injury, perhaps from the prolonged anoxia (lack of oxygen) to the brain. What else could go wrong?

I then went to the ICU waiting hall to meet my patient’s family. The room was dark, as the lights have been dimmed. In every corner of that hall, were relatives of other ICU patients, who were sleeping on the floor or make-shift beds. They have camped out in this room, some for a few days, others for weeks. I know each of them have a sad story to tell.

I found a quiet space in the waiting hall to meet with the family of my 19 year-old patient. There were two sisters, and the grandparents. We spoke softly, so not to disturb those who were sleeping. I informed them of the severity of the situation. I was frank and direct, telling them that I have no good news. It was all bad. The family was distraught. And understandably so.

When I asked them who would be making decisions in behalf of the patient, I heard more depressing news.

The family told me that it would be her mother who would make the final decisions. But she herself was sick.

The mother had been a patient in our hospital less than a year ago. She suffered a devastating stroke and was in our ICU for more than a month. She slowly improved, and after a couple of months in the hospital she eventually was discharged to a rehabilitation facility, where she stayed for several more months. Finally she was able to come home two months ago, only because his son took responsiblity of fully caring for her.

That son, was now in our ICU.

How about the patient’s father, I inquired. The grandfather glumly told me, that he died not too long ago from an accidental electrocution at work. Was this the saddest string of unfortunate stories or what?

After my talk with the family, one sister planned to get their ill mother at home, so she could see and say her goodbye to her son. And then they will decide whether to wait it out a little longer, or take him off life support.

I went back to the ICU’s workroom to write my note, and that’s when I saw my medical resident crying.

Perhaps she was emotional due to changing hormones, as she was pregnant. Or perhaps she was just exhausted, and it was already 3 o’clock in the morning. Or perhaps these medical sad stories was too much for her to handle.

I know, it was too much for me too. And twenty years of experience did not make it easier at all.

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(*names have been changed)