An article on Filipino Freethinkers captured why an alliance between UNAIDS and the Roman Catholic Church on the issue of HIV and AIDS awareness and prevention can be quite a head scratcher. The piece by Filipino Freethinkers President Red Tani sure shows the fundamental contradictions between the stances of the two groups. While UNAIDS supports the idea of the giving out of condoms to decrease the likelihood of virus transmission, the church (and the Pope for that matter) have been preaching the idea that giving away condoms to people will only make them more likely to be promiscuous – hence leading to more cases of infection.

Both sides have the right to believe what they want to believe – regardless of what scientific evidence and various studies show. No one can ever force other people to believe a certain way. What could possibly be the purpose of this partnership then?

Can the church really play a pro-active role by being really against the use of condoms?

On one hand, the church is theoretically a good ally in just about any thing in the Philippines. If you would believe the bloated statistics of so-called Catholics in the country, the population is around 80% Catholic. We all know that a good chunk of these Cath0lics are non-practising or cafeteria Catholics – the type who don’t really go to mass or just go because they have to or have nothing else to do. The message of the church about abstinence and non-promiscuity would certainly resonate among the REAL catholics. Unfortunately, the amount of people who believe in everything that the Catholic Church says is probably really small. If the 2010 elections were any indication, there were a whopping 39 thousand people who decided to follow the CBCP’s call to the public to vote for JC Delos Reyes.

I would like to thank that UNAIDS would rather have an ally – rather than an apathetic observer or even an enemy in the form of the church. The church can never really preach past their walls and influence what people do in the privacy of their own homes and other places where people like to bump uglies (sorry for the technical term). A lot of catholics don’t listen to the church at all and at the end of the day, the church really is left in an echo chamber with only its most ardent and die-hard supporters listening.

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If you have waded through the flood waters, please consider taking two tablets of doxycycline. It is an antibiotic that is supposedly not to be sold over the counter, but since we’re in the Philippines, you could probably get them even without a prescription.

If you’ve been exposed to flood water, take 2 100mg tabs of doxycycline and your chances of getting leptospirosis should somewhat diminish. This drug is relatively safe and very cheap. This is not to be taken by pregnant women or very young children though.

If you want to help, please read Manolo Quezon’s post.

Stay safe guys.

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I was assigned to rotate through different services in the Pediatric department and after an entire month of being exposed to young patients, it’s impossible to be unaffected by the degree of suffering, depression, hopelessness – and most tragically — loss.

These children are up against the toughest diseases. Some of them face the tall odds of fighting cancer at a tender age. There are babies who are also barely holding on to life while having all sorts of tubes attached to them. And then there are others with faulty hearts, kidneys and brains. They are all in one big hall – a ward – that holds the stories of sixty or so children. Each tale will tug at your heartstrings once you hear about how one mother has gone to all her province’s elected officals for help or how one father has tried working two jobs just to make ends meet.

And then… you hear that one patient has developed a pneumonia. But it’s not simple bug that goes away with the usual medication. Hospital-acquired pneumonias are notorious for being aggressive and expensive to treat. Drugs needed for therapy usually run up to about 3000 php (~75 USD!) per vial and multiple vials may be needed everyday. Clearly, most of us don’t have the money to  help out in chemotherapy and other drug expenses, so the best way for us to make a a difference is to at least do our part in making these patients and their families and comfortable and as happy as possible while they are  in the hospital.

In accordance with this, my mom and I decided to extend a simple gesture to the patients at the charity wards. On February 21, 2009, we will go to the wards to distribute  snacks, groceries and other knick knacks  that we could give the kids. If you guys have any thing that the kids could appreciate, you’re more than welcome to join us or bring em over. You may also drop by at the wards anytime  – it’s usually packed all the time so there will be lots  of kids who would appreciate your gifts.

Here are things that I think the kids would appreciate:

• Toys – keep in mind that patients aged newborn to late teener.
• children’s books
• crayons, coloring books
• clothes

Donations so far:

2/13 – A very generous woman who requested to be anonymous donated dozens of stuffed toys! Thank you ma’am! I’m sure the kids would love your gifts.

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Medical charts (or medical records) are in a lot of ways, similar to blogs. These folders contain the clinical picture of each patient that a medical facility has seen. In the Philippine General Hospital, these charts are the manuals and the how-to’s of managing a certain disease entity. Once a patient enters the wards, he or she gets assigned to service (think team) of doctors and students. That service will be responsible for that  particular patient for the rest of his/her stay at the hospital. Unlike in blogging where authors can easily go on hiatus, doctors, medical students and nurses take time in their work schedule to input their observations, suggestions, orders and instructions to other members of the healthcare delivery team.

When patients develop conditions that warrant special intervention and management by specialists, resident doctors “refer” the patient to another department and/or section in the hospital. If a diabetic patient under the Internal Medicine Department develops a gangrenous foot, the resident-in-charge would most  likely refer the patient to the Surgery Department who would in turn assess whether an operation to amputate the diseased foot would be necessary. The intention for the referral is input on the chart and it is up to the student to carry out the orders as soon as  possible.

Other ‘orders’ such as diagnostic tests, imaging and pharmacotherapeutic interventions are also written on the chart by the RIC. Other services who are co-managing the patient (via referrals) could also input alternative suggestions to the management but ultimately, it’s the service’s decision on whether to carry out the suggestion or not.

When all is said and done, you would really see that a hospital is ran on life-saving blogs – ‘visited’ by dozens of people everyday and getting comments almost every hour. If you like blogging, you may want to  consider medical school.

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Among all the things I’ve done in Medical school this year, none has brought me greater satisfaction and joy than ‘catching’ babies. For our one-week rotation under the Neonatal Intensive Care Unit service, my group was assigned to man the nursery area during our duty days. The job is very straight forward. After the obstetrician successfully facilitates the delivery of the baby (with a sometimes with a sonorous declaration of Baby Out!), the nurse would then carry the baby to our turf. As soon as the baby is placed on the basinet, we go down to work – we warm the baby using the droplight, suction the nose and mouth for fluid left over from the birthing process as well as assess the over all health and well-being of the child by weighing, measuring and examining the general anatomy of the newborn.

Most of these young ones are relatively healthy with little or no medical concerns.  These babies are almost immediately ‘roomed in’ with their mothers so that they could breastfeed as soon as possible. The mother’s milk after delivery (colostrum) is said to be rich with minerals and other substances that could bolster the baby’s immune system. Those who aren’t doing well after a few minutes of observation are put under close monitoring. If their vital signs don’t improve and clincal symptoms persist, we transport them to the actual NICU so that they’ll be given the care their conditions require. Premature babies as well as underweight are usually the ones shipped to the NICU.

I don’t know about you, but seeing an almost inactive little person clad only in blood and gunk cry, kick and grunt for the very first time in the outside world is an exhilarating experience. Cradling an infant in my arms is an amazing and absolutely exciting experience. I still think about the possibility of tripping, slipping and accidentally dropping the fragile baby on the floor but I really think that being one of the few people to ensure that the baby is off to a good start in life is a great privilege.

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After two weeks under the Departments of Neurosciences and Psychiatry, Block IV-A is now back at the Department of Internal Medicine for the homestretch of the what is by reputation, the toughest rotation in clerkship. Ironically, the Medical Intensive Care Unit has traditionally been one of the most benign (i.e. non-toxic) rotations. The manpower usually exceeds the number of patients on board so each patient would have at least two students working in tandem to fulfill laboratory and clerical requirments.

The call room is not bad as well. We share it with the five interns, but it’s definitely large enough to accomodate everyone.

 Yes, medicine has engulfed my life and I’m now reduced to blogging about these things. LOL.

The call room is a kleptomaniac’s wet dream! To  be able to deal with the demands of everyday paper requirements (abstracts, progress notes, lab flow sheets, referrals etc.), all students have at least one laptop here in the call room.This is also one of the few call rooms with access to WiFi -albeit the weak signal.  Interestingly, only DELL laptops have been able to detect and actually use this faint signal. My iPhone has also been able to tap the network. The airconditioning is actually non-existent so sweaty afternoons and duty nights are definitely on the horizon.

In other news, my girlfriend just took her oath as a physician yesterday. I am so proud of her.

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My blockmates  and I have been rotating as Surgery clerks for the  past month. We’re counting down our final days before we all move to Internal Medicine – one of the most demanding of all rotations — so I guess it’s just fitting that I chronicle how the past weeks have been for us.

Everyday, clerks are expected to be in the Clerks’ call room by 7 AM. There’s a log book in Ward 4 where you have to sign in to prove that you really were punctual for a particular day. If you fail to sign up before a resident grabs hold of the log book, you run the risk of being marked absent for the day. During the orientation, we were told that we should be prepared to everything and anything.

They weren’t kidding.

Well, outside of doing the illegal and the  lewd, clerks work like the worker ants of the Surgery ward colony. If papers need to be done, it’s the clerk’s duty to see to it that it gets accomplished at the soonest  possible time. To facilitate this better, each student is assigned a certain number of patients. He or  she then becomes  the student-in-charge for that particular case. Paperwork such as clinical abstracts, discharge summaries and referrals all fall squarely on the SIC’s shoulders. Every day, we are expected to browse through our patients’ charts to see if the residents or consultants have anything new to request – may it be in the form of a referral to certain department for co-management or additional laboratory work for diagnostics. If the patient goes to the operating room, it is also the responsibility of the SIC to assist in the operation.

There were sixteen of us and we were split up into the four services. Every week, each group of four would rotate into a new service. Each service has a specialized area of expertise and have a different composition of residents, consultants and fellows to work with.

General Surgery II (GS II) is mainly concerned with the operations of the distal bowel (i.e. the large intestines, rectum, anus etc.)

General Surgery III (GS III) deals with surgeries concerning the liver, pancreas and gall bladder.

General Surgery I  (GS I) covers just about everything else that the first two missed. Included in GS I are procedures involving the neck, face, breast, stomach and esophagus.

Every three days, GS clerks go on 24 hour duty. We spend 12 hours (6PM to 6AM the next day) in the Emergency Room to be the Surgeons-on-Duty. We are literally the first line for the Department of Surgery in the ER. It’s fun, exciting and highly educational but fatigue does set in real quickly. We are also called up to the ER whenever there’s a procedure. On average, a clerk on duty will be called for at least two procedures on any given duty night.

view from the second level bunk 

 During the day, we spend our days in the call room. We have activities like lectures, small group discussions and service rounds that interrupt our stay in this small holding chamber but nothing interrupts  like… THE RING.

Yup. The Ring scares most if not all clerks. It’s not a call room for nothing. Whenever the  phone rings, it usually means that there’s a procedure upstairs that  needs an assist. What does an assist do? Well, it can range from real back-breaking work to a relatively easy and quick task. It’s all in the luck of the draw. Those who are going to be on duty the next day (pre-duty) are first on deck when the first calls in the morning come in. Those who will be on duty that night are then sent up once the first four clerks have finished  their turn. Post-duty clerks are protected by the system. I mean, come on, how can you expect someone who hasn’t even had a decent amount of sleep to be able to hold retractors with ample effort?

By the end of the rotation, all of us would’ve been the first or second assist in more than 30 procedures ranging from appendectomies, cholecystectomies, herniorapphy and rare procedures like Whipple, gastroduodenectomy and cystectomy. That translates to hours upon hours of holding up folds of skin, pushing layers  of fat and muscle aside and unbearable moments of being unable to scratch your nose in fears of contaminating the so-called  sterile field.

With the end coming near, Surgery has proven to be nothing short of a blast. Amazing. If I had it my way, I’d love to be a surgeon.

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This won’t be your last breath, I know
I could see the tears form in your eyes
But we’ve almost made it
It will break my heart to see you go
Because we almost made it

- You’re Killing Me, Chicosci

For the past six weeks, I’ve been regularly sacrificing an entire night’s worth sleep to man my post at the Philippine General Hospital. It’s been a story of fatigue, mental anguish, twilight zone moments and stolen naps recurring every three days for four weeks running. Most students go into an entirely new setting when they’re up for a 24-hour tour of duty in the emergency room. The amount of work can be very daunting and at times, it can seem that finishing all tasks with an acceptable level of efficiency and competency is close to impossible. But I manage, we all manage. This early we’ve already figured away to circumvent challenges  to our alertness, energy level, heart strings and various bodily functions to be awake enough to triage patients, put intravenous lines, extract blood for diagnostic purposes, insert all sorts of catheters, suture nasty wounds and allay fears of nervous relatives. How do we do it? It’s part-adaptation, part-mind control and part-paradigm shift into this no-nonsense-yet-not-cold mode that we all are refining with every duty.

During the first few times that I was on duty, I never really experienced things that would jar me to reality. Prior to this year, I’ve never really seen a patient die before my eyes. There’s plenty of fight in everyone of us, but with disease, depression and financial constraints, this ability to resist and delay death becomes highly unlikely and somehow pointless. Three days ago, six patients arrested and were coded in a span of five hours. As soon as the call for code was made,  Jose (my ever trusty duty mate) I scrambled to the patient’s bedside to perform basic life support. We alternated for several minutes but after almost half an hour of fruitless bagging and chest compressions, the attending physician decided to pronounce the time of death. Being revived after the declaration of code isn’t necessarily a good thing either. The brain incurs irreversible damage after just four minutes  of being starved of precious oxygen. Each minute past four just  compounds the  likelihood of having  permanent complications arising from such an event.

I’ve seen people die. Some of them even died while I tried my best to revive them and give them another shot in living. Some of them were already in bad shape when they arrived in the hospital. By the time they reached the resuscitation area, they didn’t stand a chance against the clutches  of the reaper. It’s hard. It’s frustrating. Death crushes the ego of man like a delicate twig despite human intelligence’s tenacity to keep on holding it at bay. In the end, nature wins.

As I’ve said so many times before, working in a hospital has  made me realize how the universe is not meant to be man’s playground/gift like how most religions would paint it. Humans are a mere blip on the vast expanse of possibility in the mysterious substrate wherein all of us are suspended upon. We are the products of the process called life – a selfless pseudo entity that puts the proliferation and persistence of the species ahead of concerns of the lowly individual. Nature doesn’t really care about death. As far as life is concerned, the phenomenon doesn’t really take into consideration the quality of the life of the individual past the reproductive age. Actually, it seems  like life makes sure that the older individuals die for sure through degenerative diseases and brutal forms of aggressive neoplasia and other cancers.

 I see this drama unfold before  my eyes every day. On one hand, it’s hard to see the anguish and sonorous wails of relatives and friends when they find out of their loved one’s passing. At the same time, it’s also somehow easy because I now accept that death  is an inevitable outcome. Doctors can’t save everyone. I try my best every single time I try to compress a heart to beating to life once more, but I can only do so much. Death starts in the cellular level – a stratum that we don’t really appreciate outright. It’s amazing that the death of these cells sets up  a multitude of other events – from death to the emotional response (modulated by various molecules and neurotransmitters) that other multicellular organims manifest.

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Though I’m still a shade under two years away from completing my medical education, the current curriculum already allows students like myself to be in the frontlines in various parts of the Philippine General Hospital. In five weeks as a clerk – that’s Learning Unit VI for those familiar with the UP College of Mecidine — I’ve rotated under the departments of Anesthesiology, Emergency Medicine and Surgery. It’s been physically-tiring as well as mentally and psychologically taxing for the most part but in the end, it’s been a rush.

Death is the great equalizer. We will eventually face it one day and no matter how much we romanticize the esoteric beliefs on life-after-death, death will continue to remain as a concrete and irreversible termination of somebody’s life. It’s like having nature remind us that the phenomenon of life was never meant to look after the welfare of the individual. It was never just about man. We die – just like everything else that is living. The difference of course is that our species have figured  out ways to challenge the natural order after years of practice and research.

Imagine just how many women died during the neolithic era because of childbirth. Can you fathom how people used to die in their 30s and 40s due to epidemics that swept entire continents just a few centuries  ago? Now, we can fight back. We still see a high rate for mortality for women giving birth and we still see an alarmingly high number of HIV patients  in Sub-Saharan Africa but it has definitely improved dramatically from where we were as a species a millennium ago.

Emergency Medicine 

It was my first time to work in the Emergency Room but I’ve been always familiar with its notorious ambiance. Though the complex is relatively new, the air conditioning conked out a couple of years ago. This has made the ER a very hot and smelly place. The ER at the Philippine General Hospital challenges your conventional view of what an emergency room should be. Because of the immense number of patients already holed up in the charity wards, dozens of patients get stuck in limbo in the beds inside the Acute Care Unit. It’s a rich and often overwhelming combination of sweat, feces, necrotic material, pus, burns and just about anything you can think about. It’s a challenge but your nose will get used to it. You’ll realize you stink big time after you leave the premises though.

As a clerk, we given the following responsibilities during our two-week rotation:

Pre-duty 

Schedule: 730 AM – 500 PM (weekdays) 730 AM – 12NN (weekends)

As the name suggests, it’s the day before your duty day. Clerks who have this status are tasked to man the Triage Table. All patients that enter the emergency room are assessed by those in Triage. Based on the chief complaint, history of present illness and vital signs, the triage officer (usually a resident from the Department of Emergency Medicine) makes the call whether the patient falls under the emergent, urgent or non-urgent category. Due to logistical reasons and lack of resources, patients who could afford to move to another hospital are politely asked to transfer to another center. Some patients also consult the ER for the weirdest of reasons – non-emergency cases like slight fever, fungal infections or even requests for physical check-ups! These patients are advised to visit the Out-Patient clinics or arrange a consult with a private practitioner.

Duty

Schedule: 730 AM-400 PM; 400-7AM. (Weekends and Weekdays)

Clerks on duty stay in the Acute Care Unit to execute orders for the patients. It’s an amazing learning experience! You will  literally get all the chance to learn and perfect your techniques for intravenous line insertion, blood extraction, foley catherization, arterial blood gas interpretation, nasogastric tube insertion and even radiographic plate interpretion. When a patient goes into code, the duty team is also expected to provide basic life support by doing chest compressions and monitoring the critically ill. It’s tiring, but again, it’s definitely a rush! You’re definitely challenging death and the gravity of the situation – the sheer drama, crying relatives, adrenaline in your bloodstream – makes you want to give it your all and something extra to give the patient a fighting chance despite fatigue and sleep deprivation.

Post-Duty

Emergency Medicine is one of the most human rotations!  What do you do when you’re on post-duty status? NOTHING! You get the rest of the day off!

—

I’ll post my more EMO entry about Emergency Medicine in the coming days. Thanks for reading.

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Dark Knight  is among the most  anticipated films this year. With the very strong merits of the last Batman movie (Batman Begins) and the death of Heath Ledger – the actor who plays the intriguing role of the Joker — the movie could break all sorts of records in the box office aside from kudos from movie critics and casual moviegoers alike. The film also stars Christian Bale, Michael  Caine, Aaron Eckhart and Maggie Gyllenhall.

For those who want to watch Dark Knight before everybody else, the Philippine General Hospital Sagip Buhay Foundation  is offering premiere night tickets for the reasonable price  of 250 pesos each. Sagip Buhay Foundation is a non-stock non-profit organization that helps indigent patients in the PGH wards and intensive care units avail of potentially life-saving medications and  diagnostictests. It has been helping needy families of the seriously ill for the past fourteen years already.

For a ticket that’s not even twice the usual ticket price in SM Mall of Asia, you can enjoy Dark Knight before most people would get to watch it aside from also giving those in need a hand in helping their loved ones fight the biggest challenge of their life.

What: Dark  Knight Premiere

When: JULY 18, 2008 (Friday) 7PM

Where: SM Mall of Asia

How much: 250 pesos

Again, all proceeds go to the Sagip Buhay Foundation. For more tickets and inquiries please text Dr.  Adrian Paul Rabe  at +639163333603.

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Most people would actually write an on hiatus post  to warn their readers of an upcoming lull but unfortunately, I didn’t have the foresight to do something similar to that. For the past week, I’ve been engulfed by the art and science of Anesthesiology. I’ve been learning how to make people numb, paralyzed and amnesic for extended periods of time so that surgeons could do their life-saving work. Though most people have a dismissive outlook towards anesthesiologists, I’ve really gained a good sampling of what they could offer. Patients at the brink of death could be sustained at that point thanks to the skills of a good anesthesiologist. I’ve seen a stab patient lose more than 90% of his total blood volume and still live. That alone is a tremendous testament to the skill and competence of Philippine General Hospital-trained anesthesiologists and surgeons.

The downside to all this learning is the not-so-little problem of not having enough time to sleep, eat and yes, blog. A clerk rotating under anesthesiology is expected to spend close to 80 hours a week in the operating room – with stretches  of  continuous 36-hour shifts being the worst-case scenario.

 In thirty minutes, I’ll be back in the operating room. And yeah, anesthesiology is supposedly one of  less toxic (demanding, difficult, exhausting etc.) rotations in Clerkship. Wish me luck. :p

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Despite the high number of mortality and morbidity that Filipinos experience first-hand, people are still in the dark when it comes to concerns related to cardiovascular disease. For instance, most people would go see a heart doctor or a cardiologist if they show sudden spikes in blood pressure readings. Physiologically speaking though, hypertensive disorders would fall more into the nephrologists’ (kidney specialists) side of the court. Hypertension can potentially cause problems in the heart in chronic cases because the heart has to work against an increasingly steep pressure gradient, but in the end, the heart pathology is a mere secondary effect and hypertension is rarely borne out of a cardiomyopathologic etiology.

Most people would know that the heart is the pump that sends out oxygenated blood from the lungs to the peripheral structures of the body – i.e. everything else. All structures in the body need nourishment from the blood and the heart itself is no exception. We’ve been hearing the word atherosclerosis a lot lately because it has become one of the more epidemiologically-abundant medical phenomena of our time. As medicine improves and as the life span increases, we’re now seeing how the body reacts to a prolonged high-fat and high-cholesterol diet. Atherosclerosis is the narrowing of blood vessels due to the formation of plaques on the surface of blood vessels. Narrowed blood vessels easily translates to less oxygenation and as if that wasn’t bad enough, the plaques could rupture and cause the blood to clot. This clot could potentially case myocardial infarction or cardiac ischemia. Cardiac cell death can lead to many bad things for the patient – the most grave of course is this condition we call death.

My family has a strong history of heart disease. Atherosclerosis doesn’t limit you to dying of a simple heart attack. The plaques could also break off and cause a stroke in some other part of the body – the worst case scenarios would be the brain and the lungs.

Atherosclerosis may or may not present with symptoms. My Dad had a 95% obstructed artery, but he never experienced chest pains. An electrocardiomyogram showed that his heart was already exhibiting arrhythmia and could have had a heart attack any moment. Fortunately, he was seen by a competent doctor and ablation was done via percutaneous transfemoral coronary angioplasty.

There is plenty to learn about our hearts and how we should take care of it. Of course, I can’t expect everyone to just pick up Harrisson’s Internal Medicine or Netter’s Atlas of Anatomy all of a sudden. It’s a good thing that there are non-threatening, well-written and informative websites out there that discusses the ins and outs of medical conditions.

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All pictures were taken by the undeniably talent Julian Cañero. Well, except the ones with him on the shot.

This folks, is the famous umbilical cord. I’m sure you’ve heard of it before but I bet you’ve never seen one – unless you have unreal memory that stretches back to your fetal life. The meaty thing on the upper right hand corner is a part of the placenta. This is the organ responsible for the blood supply of the fetus during the duration of the pregnancy.After the baby is expelled, you still have to deliver the placenta.

This is Julian helping a mother delivery. You literally have to pull it out. The easy deliveries wherein the mom barely needs to do anything only happens in movies. Also, pag-ire or bearing down should not be done while making sounds. Alas, the movies got it all wrong again! Since bearing down is very similar to what you do when you try to move your bowels, certain… excreta may find its way out during the delivery. It’s very scary to pull out a baby’s head out. You’ll be instructed to pull as hard as you can and not worry about snapping the neck of the baby. And oh, look at Julian’s left arm! I sure hope mommy doesn’t have hepatitis or HIV. haha

Awwww. Unfortunately, Julian was sleeping when I delivered my patient’s baby at around 6 AM – about an hour before we were to leave — so I have no evidence of helping out in the delivery room.

I’m sure not a lot of you know this, but most of the time, scissors *YES SCISSORS* find their way into the sterile field next to the delivery table. What are the scissors for? Well you  see, a baby’s head isn’t exactly small and the opening to the vagina isn’t exactly big to accommodate the passage of that head. So to facilitate easier passage, doctors cut from patients vagina towards the direction of the rectum to increase the passable area. This mangled up flesh is then apposed and sutured (i.e. stitched) together later on. If this cut isn’t made, the damage could be more grotesque and the welfare of the baby could be compromised. There have been cases where in the vagina and the rectum ended up being just a single opening because of… well, massive tearing. *go imagine that mental picture*

If you haven’t noticed yet, we’re wearing scrubs, a  really fugly hair net and a mask that makes breathing a very tiring chore. I always wear black scrubs. On my neck are a sphygmomanometer (otherwise known as a blood pressure apparatus) and a stethoscope (handy for checking the  baby’s heart sounds while awaiting delivery. Decreased heart sounds and movement could be an indication for an emergency cesarean.

I hear yupies whine about their job schedules like drama queens and I never really let my sympathy go out to such people. Med students have it worse. We’re on 24-hour duty EVERY THREE DAYS and we don’t get the next day off. We still have to be at the hospital from 7 AM to  5 PM the next day. And oh, we’re not getting the paid like those whiners. Haha.

These three show that sleeping in weird positions and the most unlikely of places is one of the most important skills that one can  learn in med school.

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The human heart pumps on average, about 100 beats per minute. It’s a machine that tirelessly works to allow for blood circulation and ensures the oxygenation of every cell in the human body. Its work starts just mere days after conception and it will only get a brief rest in between rest in a human average life span of 80 years or so. Being a medical student, I’m aware of the things that could go wrong – from congenital anomalies, arrhythmias, valvular stenosis and regurgitation. All these things might seem Greek to the non-medically inclined, but one term would definitely connect to most people – heart attack.

A heart attack (or myocardial infarction for those who love watching House, MD or Grey’s Anatomy) happens when the blood supply to the heart is compromised secondary a narrowing of a blood vessel (atherosclerosis) or the impaction of a vulnerable plaque (embolism). This causes a condition called ischemia - a state wherein tissue is unable to get enough oxygen from the blood. Sometimes, this condition does not present with clinical symptoms and unfortunately, these silent ischemia can be silent killers. My father (quite young at 50) had an artery that was 95% occluded but he did not present with any symptoms! Luckily, the pathology was detected via electrocardiogram and through confirmatory angiography, my Dad was soon on the fast track to angioplasty – an invasive procedure that entails the dilation of narrow vessels for greater oxygenation.

It’s pretty hard to understand in technical terms, but to put it simply (as conveniently discussed by the linked page), our hearts need oxygen and that could only come from circulation. If the plumbing system of the heart becomes clogged, this could lead to the death of cardiac cells – and the patient’s as well. Given the sedentary lifestyle of most of us – and the fact that cardiovascular disease continues to be among the leading killers in the world — it’s to our advantage if we actually get to know the various risk factors and preventive measures.

Risk factors

• pre-existing cardiovascular disease
• angina
• arrhythmia
• advancing age
• history of a previous stroke or heart attack
• diabetes
• obesity
• high triglyceride levels
• high LDL levels (the so-called bad cholesterol)
• low HDL levels (good cholesterol)
• hypertension
• chronically high levels of stress

Preventive measures

• Exercise! Keep yourself fit.
• Eat healthy and stick to a low fat diet.
• have yourself checked if you have any of the risk factors.

—

This policy is valid from 04 April 2008
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Basketball superstar Rommel Adducul recently revealed to the public that he will be undergoing treatment for nasopharyngeal carcinoma. The slot man for the Purefoods franchise complained of nasal congestion during the past few days causing him to have difficulty of breathing. The nasopharynx is the the space behind the nose that is continuous with the oropharynx – the space directly behind the mouth. One of the most common presenting side is a neck mass – due to infiltration of cancer cells of neck lymph nodes — and Adducul’s teammates claim that they’ve noticed the mass since Purefoods’ last championship series.

Nasopharyngeal cancer may not ring a bell, but Southeast Asians have a greater chance of getting it compared to people from other parts of the world. The likelihood of a Filipino, Malaysian, Thai or Indonesian getting nasopharyngeal carcinoma is estimated to be between 800% to 2500% relative to people in Europe or the Americas. Male sex also carries an increased risk for developing the condition. The symptoms include nasal discharge/ obstruction / bleeding, ear symptoms (including decreased hearing and tinnitus), headaches and neck pain. As with a lot of cancer, the mechanism of developing the disease is still not clear. It has been suggested though that the Eppstein Barr Virus could transform the cells to the malignant type.

I actually have a classmate who was diagnosed with the disease a few years back and after a few months of chemotherapy and radiotherapy, he was able to bounce back and recover. The chance of recurrence is relatively low at 20%. The prognosis for Adducul’s case is actually good so we might get to see him on the court soon.

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