14 October 2004

--- OSA, COPD, and Dyslipidemia as Medical Excuses

Last Monday, The Ca t expressed disdain and skepticism over Major General Carlos Garcia's untimely hospital confinement due to difficulty in breathing.

Who is Major General Carlos Garcia?


MANILA, October 5 , 2004 (STAR) By Jaime Laude --- A two-star general was suspended yesterday for six months for alleged graft in the first such case involving a ranking Army official in recent years.

Maj. Gen. Carlos Garcia, chief of the Armed Forces' plans and programs division, had allegedly misdeclared his statements of assets, liabilities and net worth or SALN, as "his increase in net worth is disproportionate to his legitimate income," AFP spokesman and concurrent AFP chief of Directorial Staff, Maj. Gen. Edilberto Adan said yesterday.

Garcia, whose family was reported to have stashed huge amounts of money in the United States with his apparent consent, was placed on a 6-month preventive suspension without pay starting last week as recommended by the Ombudsman.

He stands accused of committing "dishonesty, gross misconduct and conduct prejudicial to the best interest of the service."

Garcia, who is slated to retire next month, could not be reached for comment. [Philippine Headline News]

Since the controversy, he has twice skipped the House investigation committee's invitation on grounds of hospital confinement.

THE COMMITTEES on national defense and banks at the House of Representatives grilled Major General Carlos Garcia's doctor on Wednesday after the military official failed anew to appear at the investigation of corruption allegations against him due to health reasons.

Ivan Villespin, Garcia's attending physician at the University of Sto. Tomas hospital, said he had advised his patient not to attend the hearing because of his condition.

Villespin said Garcia was diagnosed with "obstructive sleep apnea," a condition associated with stroke. He was also said to be suffering from "chronic obstructive lung disease (COPD) in exacerbation" and "dyslipidemia." [Philippine Daily Inquirer]

I have the highest respect to Dr. Ivan Villespin who is a pulmonary medicine specialist based in the Santo Tomas University Hospital. If he advised his patient to stay confined, I respect his medical opinion.

However, I'd like you to know what Gen. Garcia's alleged medical conditions are:
  • Obstructive Sleep Apnea (OSA) - while associated with "stroke" (and even heart disease and hypertension, for still unknown reasons) as Dr. Villespin said, the main disease condition is characterized by repeated episodes of partial (hypopnea) or complete (apnea) cessation of breathing during sleep. For brief periods, the patient literally stops breathing during sleep. In medical practice, we usually categorize apneas lasting at least 10 seconds to be of clinically significant.They usually last for 20 to 30 seconds and can last for more than a minute. Oftentimes, OSA patients have disturbed sleep architectures and hence exhibit symptoms of excessive daytime sleepiness, sometimes leading to car accidents, personality changes, decreased memory, erectile dysfunction (impotence), and depression. The most common signs and complaints of OAS patients include loud snoring, witnessed apneic episodes (cessation of breathing), and obesity. Most of their bed partners complain about their snoring. A large number of snorers are believed to have OSA. Treatment options include use of pressure devices, oral appliances, and surgical corrections.

  • Chronic Obstructive Pulmonary Disease (COPD) exacerbations - now, this is more serious, but with early and agressive treatment, this can be controlled. A COPD exacerbation, as defined by Anthonisen (and I guess this is also what Dr. Villespin uses)is characterized by increase in sputum purulence (respiratory secretions become more yellow), increase in sputum volume, and worsening of dyspnea (difficulty of breathing). COPD patients experience 1 to 3 exacerbations per year, and about 3 to 16 percent of them will require hospital confinement during these times. The main cause of these "COPD exacerbations" are infectious, usually up to 90 percent. Treatment include oxygen administration, the use of bronchodilators, antibiotics, and depending on severity, steroids on a 10 to 14-day regimen. In an acute exacerbation setting, it is no longer advised to do chest physiotherapy and administer mucolytic agents, but I've noted that most doctors here still do those.

  • Dyslipidemia - serious condition but not as serious as to prevent one from attending a committee hearing. Dyslipidemia means one has abnormal levels of lipids in the body usually the bad ones --- LDL, cholesterol, and triglycerides. Patients with dyslipidemia are at risk for stroke and heart problems. They are usually given statins, advised to exercise, change their lifestyle habits and incorporate a healthy diet program. I have been discussing these here in my past posts.
Based on the above-mentioned disease conditions, I can already picture what type of patient Major General Carlos Garcia is:
  • he is obese

  • he is probably hypertensive

  • he has a heart problem

  • he is probably diabetic

  • he was or is a chain-smoker

  • he loves to eat meat products and cakes, ice cream

  • he snores like a jackhammer when sleeping
I know Garcia's hospital timing stinks. With all the controversy and law suits filed against him, he must be very, very upset and anxious by now.

Combine that degree of agitation and anxiety with the disease conditions described by his doctor, and yes, indeed, he might get hospitalized. I suspect he is in a state of panic right now, and Dr. Villespin is doing his best to stabilize him.

If I can be allowed an analogy, this case is like that of a child hyperventilating because somebody took away his toy or candy. Lots of assurance needed.

Give him his sweet time. Pray he gets well soon. He can't run away. There's no running away.

Even if he does, those diseases will surely take good care of him.

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