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)

 

Fear of Shadows

Are you afraid of your own shadow? Here’s a story for you.

Few days ago, a patient that I took care in the hospital last month, came for follow-up in our outpatient clinic.

She was hospitalized with pneumonia, and her course was complicated with fluid collection (pleural effusion) in the chest cavity around her lungs. I placed a chest tube to drain the fluid, and creamy, yucky (yucky? that’s a medical term!), purulent material came out, a condition called empyema. But even after a couple of days of hooking the chest tube to suction (like a vacuum cleaner), it did not drain completely. The fluid was so thick and was gel-like already. Thicker than condensed milk!

chest x-ray with left pleural effusion (the L indicates the left side)

Finally, I consulted a thoracic surgeon, and our patient underwent surgery to evacuate the crap (crap? that’s another medical term!) and scrape clean the thoracic cavity, a surgery known as decortication. She made swift recovery thereafter and was eventually discharged home.

When I entered the examining room on her follow-up, I sensed anxiety on her face. I asked her if she still feels sick, but she denied it, and in fact she admits that she was really doing well. I told her that her chest x-ray, which was taken earlier that day, looks good and I was satisfied with her progress. To this she said: “But there’s still a large shadow in my chest. There must be still fluid there.”

Obviously she peeked on her chest x-ray, probably in the Radiology Department, prior to coming to our clinic. I was astounded by her remark, as I reviewed the x-ray myself. Are we looking at the same film? Does she know something that I don’t?

I then led her to the computer screen to review the digital film with her. She then pointed on the “shadow” in the middle of her chest x-ray, that was causing her concern.

I tried to contain my smile as I reassured her that the “shadow” was alright, because that shadow is her heart. “Then I am glad that shadow is there,” she declared, as she sheepishly laughed with relief.

normal chest x-ray

We sometimes fear shadows, even our own, when we should be focusing in the light.

“No man sees his shadow who faces the sun.” – Danish proverb

 

* Chest x-rays were not from the actual patient

Debunking Folks’ Medical Advice: Part 2

Here are more old folks’ medical advices that I remember receiving personally or hearing from somewhere else, while I was growing up. Let us examine if there’s medical validity behind these folks’ counsels.

1. Huwag mong hayaang matuyo ang pawis sa iyong likod, ito ay sanhi ng pulmonya.

Do not let your sweat-soaked clothes dry up on your back, you will have pneumonia.

Pneumonia is an inflammation of the lungs usually caused by an infection. This is most commonly due to virus or bacteria, that gained access to your lungs through inhalation or aspiration. Frequently, a healthy immune system is able to fight off these organisms that invade the lungs. However, it can sometimes be overwhelmed, and the result is pneumonia.

We catch viral pneumonia when we are exposed to somebody who is infected with it, when they cough or sneeze and spread the germs in the air and in things around them. Most of the bacteria though that causes pneumonia, already inhabit our mouth and throat, and are just waiting for you to let them in into your lower respiratory tract. Our body’s defense mechanisms (like cough reflex) and immune system keep them in check.

Getting wet in the rain or letting your sweat soaked clothings dry up on you, does not cause pneumonia. Some experts have examine if these can lower our immune defenses, but current medical studies indicate that they do not.

So don’t worry about having your sweat-soaked shirt dry up on you. Just be considerate of other people who will have to put up with your stinky smell, so might as well change your smelly shirt. And go ahead and play in the rain, just watch out for the lightning!

2. Huwag mong pahamugan ang bunbunan ng bata, baka ito sipunin.

Do not let the head of the child be exposed to dew, he will catch cold.

Colds are caused by respiratory viruses. Again, we catch them if we are exposed to people who likes to share their viruses, even if you don’t want them. If you don’t breath at all, you may prevent inhaling the virus, but is not recommend for obvious reason.  And if you caught the virus, please don’t share it further by taking proper precautions, like covering your mouth when you cough or sneeze and by frequently washing your hands.

Being exposed to the night dew is not a direct cause of colds. However if your putting a hat or covering the head of a child because of frigid temperature, then that is something else, and that is very appropriate.

3. Huwag kang matutulog ng basa ang buhok, at baka ikaw ay mabulag.

Do not sleep with your hair wet, you will go blind.

There is no medical truth to this. I believe this advice is perpetuated by older folks who don’t want to get the pillow wet, which can get wet anyway with drool. The only thing you will get by sleeping with wet hair, aside from wet pillows, is waking up with bed head hair. However, a bed-head-hair-look is considered fashionable and stylistic nowadays.

If you wet your hair with kerosene, then that is a different story.

4. Huwag mong paglaruin ang mga bata sa init ng araw, at baka sila magkakuto.

Do not let you kids play under the heat of the sun, they will have head lice.

Head lice is an infestation caused by a parasitic insect, Pediculosis capitis. These parasites feed on blood like mini-Dracula. Head lice is spread from direct head to head or close contact from an infested person. Sharing a comb, headgear, beddings or clothings are the most common ways of spreading this.

The sunlight does not cause lice. In the contrary it may even help get rid of it. Hanging bedsheets in the sunlight might help kill lice and its eggs. But exposure to sunlight alone will not kill these parasites in the human scalp, unless you get very high UV light and reach very high temperature, like when you migrate to Mercury.

There have been many folk remedies suggested like vinegar, mayonnaise, olive oil, and butter (sounds like making a salad in your head!). The scientific evidence on these home remedies are not clear. I would recommend you ask your doctor for the proper treament of head lice.

So let your kids play in the sun. Just remember exposure to too much sun causes sunburn and skin damage, and in addition, increases the risk of developing skin cancer later on in life.

5. Huwag umupo sa nakabilad o maiinit na upuan, dahil ito ay sanhi ng balisawsaw.

Do not sit on seats that are hot or exposed to the sun, it can cause frequency or dysuria.

Frequency and dysuria are often times symptoms of urinary tract infection (UTI). And  UTI are caused by bacteria that have gained access into the urethra and bladder or even up to the kidneys. Women are more prone to UTI than men due to their shorter urethra. Sitting on a hot seat has nothing to do with this.

The only people that I would like to be in the hot seats  are the corrupt politicians, and may they suffer balisawsaw.

6. Kumain ng  butiki para mawala ang iyong asthma.

Eating house lizard is a cure for asthma.

Asthma is a chronic lung disease that causes inflammation and narrowing of the airways. The exact cause of asthma is not fully understood, though experts believe it is a combination of many factors, like genetic predisposition and certain environmental exposures.

There is no cure for asthma, but it can be controlled with treatment. Treatment includes medicines like inhalers as well as preventive measures by avoiding the known triggers of asthma, like smoking, dust (house dust mite, which is in the dust is a well known trigger) and extreme temperatures.

A  grilled house lizard is not a cure for asthma at all. It may be a cure for a hungry stomach.

7. Uminom ng tubig dagat kung ikaw ay may sipon o ubo, upang ito ay gumaling.

Drink sea water when you have cough and cold, for this will cure it.

I have heard that parents especially in the provinces, tell their children when they have a cough or cold, to go and swim in the ocean, and take a gulp of seawater while they are in it. This may be that the ocean in the provinces are clean and clear. I don’t think any parent will advice their kid to take a gulp of water from Manila Bay (might as well drink from the toilet bowl!).

This is an interesting advice. Saline water (not necessary ocean water), has a lot of medicinal uses. It is used to irrigate the nose and the sinuses in patients with nasal congestion and obstruction. Hypertonic saline is also given as a nebulization (inhalation of mist) in patients with chronic lung disease, especially in Cystic Fibrosis, to break and loosen their phlegm. Gurgling warm salt water can also soothe a sore throat.

In spite of medicinal usage of saline water, there is no medical facts behind the advice of drinking ocean water to treat cough and colds. As a lung specialist, I am not recommending drinking seawater. And certainly I am not recommending inhaling it, that is called drowning!