EQUAL-OPPORTUNITY KILLERS
--- Preventable Heart Attack Risk Factors

BEFORE: The conventional wisdom among cardiologists and most doctors is that about HALF of the risk of a heart attack can be prevented.

TODAY: The latest study presented in Munich two days ago, indicated that about 90 percent of the causes of heart attacks can be averted.

Dr.Salim Yusuf, who led the INTERHEART study that looked at cardiovascular risks in more than 29,000 people in 52 countries, presented the results last August 29th at the European Society of Cardiology Conference in Munich, Germany.

Among the risk factors identified to cause almost ALL heart attacks worldwide are:

• Smoking


• Abnormal Cholesterol


• Diabetes


• High Blood Pressure


• Stress


• Abdominal Obesity


• Sedentary Lifestyle


• Eating too few fruits and vegetables
[Reuters]

What do you notice among these risk factors?

According to Dr. Yusuf, "The impact of these risk factors in developing heart disease is global; it is there in every ethnic group, in men, in women, in every region of the world, in young and old. Since these risk factors may all be modified, this is remarkable and will change the way we look at heart attack prevention. It means we should be able to prevent the majority of premature heart attacks in the world."

That I think is the key word: PREVENTABLE

It means our outcome as a heart attack victim is based largely on HOW WE CONDUCT OUR LIVES. If we decide to design our lives trying to prevent or minimize most of the risk factors mentioned, even with a genetic predisposition, I think we have a fighting chance.

And while you're at it, why not grab some dark chocolate?

Another recent study says that eating dark chocolate helps prevent hardening of the arteries that leads to heart attacks. [Scotsman.com]

Dark chocos are a favorite of mine. This is great!

A word of caution though --- take it moderately, ok?

The dark chocolate study results while beneficial, "does not mean chocolate binges will ward off a heart attack." Any weight gained from eating a lot of dark chocolates would probably cancel out the apparent benefit.

Live healthy guys. You'll find it rewarding later on.

NURSE-RETURN PROGRAM
--- Delayed Reactions of a Hypothyroid Patient

Fely Marilyn Lorenzo, head of the University of the Philippines Manila Institute of Health Policy and Development Studies (UPM-IHPDS), announced that the

"departments of Labor and Employment and Foreign Affairs (DOLE and DFA), and the Philippine Overseas Employment Administration (POEA), are working on a 'nurse returning program' that could be implemented in 3 years."
[Government Hopes To Lure Expat Nurses Back --- INQ7.net]

The said technical group will seek to answer what particular countries the nurses are going to, and how good their working/living conditions are compared to the Philippine setting. As soon as the study winds up, Lorenzo said:

"We will have jobs for them, maybe as clinical specialists. That is part of the career path. Of course, we cannot match their salaries abroad but (the pay may be) higher (here) than the regular salary if they have acquired skills."

Jobs for nurses as clinical specialists with higher pay than the regular salary?

That may not be enough to lure them back or to make new nurses choose the homeland over the western countries.

And if this study will take 3 years to complete, before the government acts, it might be too late.

Lorenzo also scored the bilateral agreement issue saying that presently it is the foreign recruiters controlling the tempo of the hiring arrangements, with the government being left in the background.

Hypothyroidism is a condition in which the body lacks a sufficient thyroid hormone supply. The thyroid hormone is responsible for accomplishing most of the body's metabolic processes. People with hypothyroidism have symptoms associated with a slow metabolism. Fatigue, weakness, depression, and memory loss are some of its symptoms.

Will you blame me if I think the government's response to this problem is a bit like that of a hypothyroid patient?

FILIPINO OLYMPIC PERFORMANCE
--- Our Participation and Absence

It is now Day 16 of the 2004 Athens Olympics. I have been meaning to write something about the Olympics but kept postponing it until now because I continued hoping that our athletes will somehow bring a medal. Even one bronze Olympic medal would have made me happy. The Philippine athletes fought and lost again.

Here is the current medal tally from the Athens 2004 website. Do you see the Philippines in the list? Did you know that we began joining since 1928?

What is wrong with Filipino athletes?

Since we joined the Olympic games, the best we have achieved are two silver medals: the first one by boxer Anthony Villanueva in Tokyo in 1964, followed 32 years later by another boxer, Mansueto Onyok Velasco. We also have won seven bronze medals over the years: 2 in swimming by men's 200m breaststroker Teofilo Yldefonzo in the 1928 and 1932 games, 3 in boxing, and another 2 in athletics.

Our last great Olympic performance was the 1996 silver medal. In Sydney and in Athens today, we have achieved nothing but participation. Our absence in the medal standings may hardly even be noticed by other countries. After all, years and years of losing have established our reputation as a non-competitor.

During the 2000 Sydney Olympics four years ago, Dartmouth College professor Andrew Bernard and Berkeley's Meghan Busse astounded everyone when they were proven exactly right on their advance expectations of the total number of medals the US would win ---it was 97 --- as well as the number of golds, which was 37. They were also exactly right or off by just one medal in the case of 10 other countries.

With these anemic showings, I went on to analyze and research what can be done to improve our chances of winning.

According to Bernard and Busse, there are four key factors that influence a country's ability to win medals:

1. real gross domestic product or GDP - no money means not much training support for athletes
2. a country's population - pertains to a pool of possible athletic candidates to choose from
3. record of past success - those with proven track records have a clear advantage
4. a host effect - the home-court advantage

I also ran across how the Chinese trains its Olympic athletes:

"This assembly line of pain at the Weilun Sports School in China's southern Guangdong province asks an extraordinary amount from its 1,000 full-time students. Here, in the cavernous gymnastics classroom, the girls are drilled again and again as if they were in competition, with judges monitoring their frozen smiles. THEY MUST NOT SHOW WEAKNESS, no matter how grueling the exercise. 'Big smile, little friend,' yells Coach Yang Yaojun as the girls go through 50 reps of leg kicks with weights tied to their calves. Yang's wife, also a coach, observes: 'Maybe to foreigners, this looks cruel. But it's because we start kids very young and train them hard that we have become so successful in gymnastics.' Says her husband, who has been coaching since 1983: 'THE CHINESE RACE KNOWS HOW TO ENDURE HARDSHIP. Our job is to PUSH these kids TO THEIR LIMITS, so they can perform gloriously for our nation.' Behind him on the wall, below oversized Olympic and Chinese flags, giant red lettering summarizes the motto of the Weilun school, proud breeding ground of eight athletes at this month's Athens Olympics: 'PATRIOTISM, UNITY, STRUGGLE and DEVOTION' [ TIME Asia Magazine, August 9 issue, all caps and bold words mine]

With the current financial crisis, our GDP maybe down but I think we can take advantage of our population and past Olympic successes.

We need the political will to institute and implement a training program like that of China, which transformed itself dramatically from a sporting nobody with a mere 5-gold-medal haul in 1988 to an awesome juggernaut with 28 golds in 2000. During the 2000 Sydney games, China was #3 in the overall medals tally, trailing behind the US and Russia. And if you see the current medal standings above, China is now number TWO.

Can you imagine what China can do with its "host-effect" advantage in the Beijing 2008 Olympics?

Now, don't get me wrong. At this point, I do not want the Philippines to be in the same playing field as China. But we can at least try to, right?

Marami pa tayong kakaining bigas (We have lots of preparation to do).

Oh yes, I know that. But we got to start now. In China, they recruit children as young as 6-7 years old from their rural areas and train them 6 hours per day 6 days a week years before the Olympic games. Read about China's punishing training program for its Olympic candidates here and here and be amazed.

Why not do that?

China's claim that they know hardship is not foreign to us. Hah! We know hardship, too. What we lack is discipline and the HEART to be NATIONALISTIC enough to make this country great again. As for financial support, why not ask the taipans and other business tycoons to support our athletes?

Manny Lopez, head of the Philippines' Amateur Boxing Association is scratching his head after the debacle that has befallen the Philippine boxing team. When the second round of the Olympic boxing competitions ended, the four Filipinos had been wiped out:

"I've been trying to figure out what went wrong. I would be a fool not to admit that something is wrong with our boxing program. It is quite obvious we are not doing well."

Not just the boxing program, Manny. I think the whole Philippine Olympic team needs an overhaul and a new set of athletes and coaches.

Xu Guangshu, former principal of the Shichahai Sports School in Beijing, which is another Olympic cradle for producing China's awesome athletes, has this to say,

"Just name the sport, if you give us enough money for proper training, we can create Olympic stars. WE HAVE SO MANY CHILDREN TO CHOOSE FROM." [ TIME Asia Magazine, August 9 issue, all caps and bold words mine]

So do we, Mr. Guangshu, so do we.

I hope we get our act together for Beijing 2008.

DYING THE ELISABETH KÜBLER-ROSS WAY
--- Death Pioneer Has "Graduated"

Elisabeth Kübler-Ross, the Swiss-born psychiatrist responsible for demystifying death and dying through her more than 20 books died in her home in Scottsdale, Arizona last Tuesday. She was 78.

In her now famous 1969 book, On Death and Dying, Kübler-Ross popularized the concept of the dying going through five stages of grief: denial, anger, bargaining, depression and acceptance. In one her latest works, in her 1997 autobiography titled The Wheel of Life, she expressed her desire that she wanted her death to "come as a warm embrace."

And I think it did. She expired surrounded by her children, relatives, and friends.

"For the past two years, I have --- thanks to a series of strokes --- been totally dependent on others for basic care. Every day is spent struggling to get from bed to a chair to the bathroom and back again. My only wish has been to leave my body, like a butterfly shedding its cocoon, and finally merge with the great light," she wrote in that book.

For her own death she has been in the acceptance stage for years, according to her son, Kenneth Ross. "For her, death was not something to fear. It was like a graduation," he said. [MercuryNews]

As a final tribute to her, I share with you some of her quotable quotes (from her website and hope that even in death, she may continue to enlighten you that death is not to be feared, because likened to a journey, it is just one of those stations where you must pass in order to get to your true destination.

"Dying is nothing to fear. It can be the most wonderful experience of your life. It all depends on how you have lived. If you live each day of your life right, then you have nothing to fear."

"And after your death, when most of you for the first time realize what life here is all about, you will begin to see that your life here is almost nothing but the sum total of every choice you have made during every moment of your life. Your thoughts, which you are responsible for, are as real as your deeds. You will begin to realize that every word and every deed affects your life and has also touched thousands of lives."

"It is only when we truly know and understand that we have a limited time on earth --- and that we have no way of knowing when our time is up, we will then begin to live each day to the fullest, as if it was the only one we had."

"We run after values that, at death, become zero. At the end of your life, nobody asks you how many degrees you have, or how many mansions you built, or how many Rolls Royces you could afford. That's what dying patients teach you."

"Guilt is perhaps the most painful companion of death."

"For those who seek to understand it, death is a highly creative force. The highest spiritual values of life can originate from the thought and study of death."
-- Elisabeth Kübler-Ross (see her website)

Micketymoc of Stepping on Poop also has a great post on Elisabeth which you might want to read. Check it out here.

WOMEN, SOFTDRINKS, AND FRUIT PUNCHES
--- A Confirmed Revelation

This post is not trying to be sexist.

It just happens that the latest issue of the JAMA carries a study that links diabetes incidence among women who drink more than one sweetened soft drink a day. [JAMA 2004;292:927-934]

The study involved 91,249 diabetes-free women who were followed up from baseline in 1991 until 1999. Results showed that "weight gain over a 4-year period was highest among women who increased their sugar-sweetened soft drink consumption from 1 or fewer drinks per week to 1 or more drinks per day," and it also revealed that "increased consumption of fruit punch was associated with greater weight gain," and "increased diabetes risk."

This confirms what we have long suspected: that increased sugar consumption (softdrinks and fruit puncehes being good examples) can lead to weight gain and increase your diabetes type 2 risk --- as much as 83 percent compared to women who drank less than one fruit punch or soda a month. I think it is just coincindental that women were used in this Harvard study; I think if it involved men, reproducible results can be obtained, too.

As expected, the softdrink industry thrashed these findings, sayingg that women who drank more sugary sodas also smoked, ate more and exercised less than non-soda drinkers. In a statement issued by the American Beverage Association, they said, "It is inexplicable that the authors have chosen to focus solely on sugar-sweetened beverages in this way." [No One Food Increases The Risk For Type 2 Diabetes]

That's what they say. And that is expected from the billion-dollar softdrink industry to protect its interests. But as a health professional, my interests involve informing you of the the risks you are heaping on yourself when you take in too much of these beverages.

The table on the right (taken from Saveharry.com) tells you the amount of sugar found in most common softdrinks. A press release by a marketing firm in 2000, tells us that "1 of every 4 beverages consumed in America today is a soft-drink," and that picture I think is not so dissimilar here in the Philippines. In a typical meal, isn't softdrinks one of the usual orders for beverage drink?

Let's quantify the figures from the table, guys.

What is 40 grams of sugar in a regular softdrink? That is equivalent to 10 TEASPOONS of sugar! As I've asked before, would you swallow 10 teaspoons of sugar in one sitting? You would or you always do when you take in its camouflaged form --- softdrinks.

Now since everyone you know these days has diabetes or a relative that has diabetes, it is not good for you to further increase your risk and gamble when diabetes type 2 will manifest in your body. You must help yourself. As Santi said about smoking, this preference for softdrinks has I think also something to do with "putting your desires above your concerns or self admission."

If you think you are already at risk for diabetes type 2 and its complications, either because of your high fasting blood sugar levels or because of a strong family history, it is time for you to MAKE A DECISION NOW if you want top live longer or healthier WITHOUT diabetes or to just wait for it to happen and act later.

It's your choice.

A THOUSAND WORDS
--- Have You Been To España River?

Have you been to España River? It is a couple of blocks away from my place.

It is right in the heart of Manila and near Asia's oldest and historic university, the University of Santo Tomas.

This is how bad or how good it was yesterday depending on how you look at it. I know it costs a lot to buy a jet ski and to find a body of water to use it. I didn't know that I need not go to Subic anymore to jet ski.

The picture on the left is from today's issue of the Philippine Daily Inquirer (PDI) and as I expected, the 6-hour straight downpour yesterday caused the evacuation of "12,000 Metro Manila residents" and unfortunately, the deaths of 6 people, most of whom are CHILDREN.

An interesting excerpt from the flood news of the PDI is this:

"The almost nonstop monsoon rains that paralyzed much of Metro Manila and forced some airlines to cancel their flights were 'ABNORMAL' by established weather patterns, said Nathaniel Cruz of the Philippine Atmospheric, Geophysical and Astronomical Services Administration (PAGASA).

"From 2 a.m. to 8 a.m., a total 136 millimeters of rain --- which translates to '136 million liters per hectare --- fell on the metropolis, Cruz said.

"'That's already roughly equivalent to the normal amount of rain in May, which ranges from 100 to 200 mm, or ¼ the rain expected in August, when the monthly average is 400 mm,' he explained in an interview.

The country is well into the wet season, Cruz said, but 'WHAT IS ABNORMAL WAS THE INTENSITY' of yesterday morning's downpour. 'We've had many monsoon rains this year but not this intense.'

Cruz said PAGASA had predicted there would be rains 'but unfortunately, we don't have enough instruments or facilities that can help us estimate the amount of precipitation or rainfall in a mass of cloud.'

He estimated such equipment could cost P15 MILLION." [PDI - Aug 26 issue /All caps and bold words mine.]

Is P15MILLION that costly an investment if it will mean saved lives, less evacuation, less illnesses, and less accidents?

This is 2004. But I feel like I'm in the 18th century. On second thought, scratch that. Maybe it was a lot better back then.

THREE SIMPLE PROBLEMS
--- Remain Unsolved

As I type this post, it is raining kangaroos and hippos outside my abode. I have deviated from the "raining-cats-and-dogs" description because that adjective seems too simplistic from what's happening.

Since 1-2am this morning, torrential rains have started pouring. There is no typhoon. There is nothing our weather bureau has announced which can cause alarm.

BUT.....if you go outside, and I don't know HOW I can get out (I do not own a Humvee), the local AM radio describes most Metro Manila streets as submerged under flood waters.

What I can't believe is that Malacanang, DECS, CHED, MMDA, LGUs or whoever SHOULD BE RESPONSIBLE about cancelling classes or work for the safety of everyone, is as puzzled as I am.

This is not the first time it happened. And they say EXPERIENCE is the BEST teacher. Hah! Not in these parts! No sir!!!

I remember my elementary days and it was always like this.

NO ONE has solved this problem that has caused so many flus, common colds, leptospirosis, and have I mentioned --- deaths?

I do not know what or who to blame anymore: the President, the MMDA chief, the DECS Secretary, the Mayor, the lowly Barangay Captain?

Who? You tell me.

The usual rule is leaving the discretion to cancel work and classes to the respective employers or school authorities. But do you know HOW CONFUSING THAT CAN BE?

This is a simple problem with a SIMPLE ANSWER. I need not insult the intellects of those concerned by spilling out the simple answer.

Oh, this post is long already and I have NOT discussed the other 2 SIMPLE problems.

They are TRAFFIC and GARBAGE DISPOSAL.

But wait. If you cannot solve the FLOOD PROBLEM, should I expect the other two to get solved.

You tell me.

I'm getting incensed again.

AREN'T YOU TIRED OF THOSE NO-SMOKING ADVOCACIES?
--- But You Know I've Got To Do This

I can be a killjoy most of the time.

But they say a true friend tells you not only the good things about you, but also the BAD ones which can harm you.

So for this post, I'm not going to yak again about the dangers of smoking. I'm sure the deluge of information against smoking has already reached you by this time.

The following link is just another of those latest findings against smoking.

If you really think you can't quit smoking, and that like those 'crazy' advocates, I am just pulling your leg, then don't bother wasting your time reading this post or clicking that link.

[Smoking Ups Heart Attack Risk in Adults Under 40 | Reuters.com]

SORE EYES ALERT
--- What To Do About It

"SORE EYES DOWNS WORLD'S 9th MOST POWERFUL WOMAN" was the title of the Philippine Star's news feature last August 22, obviously referring to how conjuctivitis has affected President Gloria Arroyo (GMA), who has recently been named by Forbes magazine as the world's 9th most powerful woman. GMA got the sore eyes after she came back from Cebu City visiting the newly painted Malacanang Palace of the South.

Sore eyes, which is also known as "pinkeye" and conjuctivitis has just made a comeback lately.

Conjunctivitis is defined as infection of the conjunctiva, which is the thin, translucent, relatively elastic tissue membrane lining of the white of the eye and the inside of the eyelids. I will enumerate now the 3 common types and their respective symptoms so you will be forwarned:

1. Viral - reddish, with watery discharge, and infection usually begins with one eye, but may spread easily to the fellow eye. This is also more often associated with an upper respiratory tract infection (URTI), cold, or sore throat. This is explained by its causative organism --- the adenovirus --- which is the most common cause of viral conjunctivitis, although it can also be caused by other viruses. This type is the MORE contagious type, and is seen as the culprit in most community epidemics, with the virus transmitted in schools, workplaces and yes, even in doctors' clinics. The usual modes of transmission are contaminated fingers, medical instruments and swimming pool water.


2. Bacterial - reddish also, but this time the discharge is stringy, parang pisi pag tinatanggal mo, and causes the lids to stick together, especially after sleeping, parang sinemento o nilagyan ng glue, making it difficult for you to open them. Most patients with this condition often report that their eyelids are matted together on awakening. Conjunctival and mild eyelid swelling may also be complained. There is also notable increased tear production, a "gritty feeling" when you blink, parang me buhangin (feels like there is sand inside when you blink), and just like the viral type, it may also initially affect only one eye, but may spread easily to the fellow eye. Bacterial conjunctivitis is also often caused by bacteria such as staphylococcus and streptococcus. Infections with Streptococcus pneumoniae and Haemophilus influenzae are more common in children, while Staphylococcus aureus most frequently affects adults.


3. Allergic - less redness, but distinct complaints are the excessive "ITCHY FEELING" in the eyes and eyelids portion. The eyelids are also notably swollen. This condition is usually, although not invariably, seasonal. More often than not, there is personal or family history for other atopic conditions, such like allergic rhinitis, asthma or eczema.

WHAT TO DO WHEN YOU HAVE SORE EYES?

Well, the first thing to do is see your ophthalmologist. The eyes are delicate and very important structures of your body and they necessitate proper care and attention by the RIGHT people.

Often, the usual habit in cases of infection is just to get the advice of a friend who had it before, or to borrow whatever "effective eyedrop" worked for your friend. I'd like to tell you that you may not be helping yourselves when you do that. Since the condition is contagious, bacteria or viruses might have contaminated the tips of the containers of any "borrowed medicine eye drops," and instead of getting better, you might be re-infecting yourself with more harmful organisms.

I would like to offer some TIPS you can do if ever you contract sore eyes. The management is usually dependent on the type of conjunctivitis you have:

1. For Viral Conjuctivitis - since this is a viral condition like your common cold, there is NO CURE, but don't fret. Management here is usually supportive, and symptoms can be relieved with cold compresses and placing artificial tears (buy from your favorite drugstore). In worst cases, your ophthalmologist may prescribe topical steroid drops to reduce the discomfort. A period of 3 weeks is usually necessary for viral conjunctivitis to resolve.


2. For Bacterial Conjunctivitis - depending on the type of bacterial organism that infected your eye, your ophthalmologist will usually prescribe an eye antibiotic that you need to apply 3-6 times per 24-hour period based on the severity of the infection. It is unfortunate that there is still no single broad-spectrum antibiotic that covers ALL potential conjunctival bacterial pathogens. In choosing an appropriate topical antibiotic, you should ask your doctor to consider the cost of your eye medicine (one of the most expensive medicines around!), the effectivity, and you should also demand from them an explanation of the possible side effects of each medication. Based on practice, when it comes to eye medicine preparations, solutions are preferred by most adults and adolescents, while ointments are better tolerated by young children, who are less apt to complain about associated blurring of vision.


3. For Allergic Conjunctivitis - here, the primary mode of treatment rests on the proper identification and avoidance of the causative allergen. Cold compresses can also help alleviate the symptoms. Your ophthalmologist will most likely prescribe vasoconstrictors, antihistamine drops, topical nonsteroidal anti-inflammatory agents (to relieve the pain) and mast-cell stabilizers (mast cells produce histamine which causes the allergic reactions) like cromolyn sodium or lodoxamide. He may also prescribe oral antihistamines.

HOW CAN YOU PREVENT GETTING INFECTED?

My favorite advice to prevent most infectious diseases from spreading: WASH YOUR HANDS OFTEN and THOROUGHLY!

There is a PROPER way to wash your hands thoroughly: click here for the CDC link I want you to read.

Additionally, you can do the following:

• avoid touching or shaking hands with infected people


• if you shook hands and touched them, avoid touching your face


• wash your hands, wash your hands, wash your hands!


• do not share or reuse your handkerchiefs, towels, or washclothes; using a disposable tissue is best


• do not swim in infected swimming pools


• regularly disinfect surfaces like your working areas, tables, doorknobs, etc., with a diluted bleach solution


• if you know someone with sore eyes, advise that person to stay home until he gets better

Now, that President GMA has finally admitted that we are indeed in the MIDDLE OF A FINANCIAL CRISIS (I congratulate her! this is a positive move for me), the last thing she needs while perusing the financial books and analyzing how to remedy it --- is the pesky conjunctivitis. I pray she gets well soon so we can all get out of this mess at the soonest possible time!

I GOT YOUR MAMA!
--- Christianity and the Troublemaker


Little Leroy came into the kitchen where his mother was making dinner.

His birthday was coming up and he thought this was a good time to tell his mother what he wanted.

"Mom, I want a bike for my birthday."

Little Leroy was a bit of a troublemaker. He had gotten into trouble at school and at home. Leroy's mother asked him if he thought he deserved to get a bike for his birthday. Little Leroy, of course, thought he did.

Leroy's mother, being a Christian woman, wanted him to reflect on his behavior over the last year and write a letter to God and tell him why he deserved a bike for his birthday.

Little Leroy stomped up the steps to his room and sat down to write God a letter.

LETTER 1:
Dear God:
I have been a very good boy this year and I would like a bike for my birthday. I want a red one.
Your friend,
Leroy

Leroy knew this was not true. He had not been a very good boy this year, so he tore up the letter and started over.

LETTER 2:
Dear God:
This is your friend Leroy. I have been a pretty good boy this year, and I would like a red bike for my birthday.
Thank you,
Leroy

Leroy knew this was not true either. He tore up the letter and started again.

LETTER 3:
Dear God:
I have been an OK boy this year and I would really like a red bike for my birthday.
-Leroy

Leroy knew he could not send this letter to God either, so he wrote another letter.

LETTER 4:
Dear God:
I know I have not been a good boy this year. I am very sorry. I promise I will be a good boy if you just send me a red bike for my birthday.
Thank you,
Leroy

Leroy knew, even if it was true, that this 4th letter was not going to get him a bike. He was not good at keeping his promises, too.

By now, Leroy was very upset.

He went downstairs and told his mother he wanted to go to church.

Leroy's mother thought her plan had worked because Leroy looked very sad.

"Okay, Leroy. Just be home in time for dinner," his mother said.

Leroy walked down the street to the church and up to the altar.

He looked around to see if anyone was there. He picked up a statue of the Virgin Mary.

He slipped it under his shirt and ran out of the church, down the street, into his house, and up to his room.

He shut the door to his room and sat down with a piece of paper and a pen.
Leroy began to write his 5th letter to God.

LETTER 5:
Dear God:
I GOT YOUR MAMA! IF YOU WANT TO SEE HER AGAIN, SEND THE BIKE.
Signed,
YOU-KNOW-WHO

_______________________________

This was sent to me by email. I do not know if its a joke or a satire to remind us of something.

Anyway, I wish you all a happy Sunday!

DEATH BY THE NUMBERS
--- You Would Be Surprised

Dr. Philip Chua, a physician-columnist of Malaya newspaper showed recently "the most common actual causes of death in the United States" [Philip S. Chua, MD - Malaya].

It looked very interesting:

1. Tobacco - 435,000


2. Poor Diet and Physical Inactivity - 400,000


3. Alcohol Consumption - 85,000


4. Microbial Agents (influenza and pneumonia viruses) - 75,000


5. Toxic Agents (pollutants and asbestos) - 55,000


6. Motor Vehicle Accidents - 43,000


7. Fireams - 29,000


8. Sexual Behavior - 20,000


9. Illicit Drug Use - 17,000

What do you think is the common denominator in the list?

The list might pertain to Americans, but I'm sure the Philippine picture is not too far from the ranges presented.

Most are attributable to lifestyle whims and attitude brought about by our lackadaisical ways and mores.

Life has never been this easy. With bluetooth, wi-fi, and the internet, the only part of the body that exercises the most is either the thumb or the index finger. The waist and tummy area, however, gets bigger and bigger every day.

Can we go against the tide and live longer?

Or are all these the inevitable outcome of progress?

DIABETES AND HEMORRHAGIC GASTRITIS
--- A Reader's Request Post

Recently, a new reader and a new blogger --- BongK --- requested that I post something on diabetes and hemorrhagic gastritis. I was quite amazed why a reader on his first visit would request on very specific topic conditions. When I visited his weblog, I found out that he has been absent from work for almost a week because her mother was hospitalized and the said conditions were part of the diagnosis. So, this post is my answer to that request. I hope other diabetic readers and those with relatives with diabetes will get enlightened too.

When DIABETES is mentioned, what is the first thing that comes to mind?

Ask the Filipino passerby and he will tell you it has something to do with blood sugar, eating sweets, "nilalanggam na ihi" (ant-attracting urine), cataracts, and probably an amputated limb or a wound that will not heal. All of these answers are correct and indeed, this goes to show us that the Filipinos' familiarity with the condition need not come from attending medical conventions but maybe because a relative or someone they know is diabetic, and they have noted the said observations.

Basically, diabetes is a disease wherein the body does not produce or properly use insulin. As you all probably know by now, the hormone insulin is necessary to convert sugar, starches and other food (carbohydrates) into energy needed for daily life.

Tito Rolly, who is also a diabetic, asked me before what is the difference between Type 1 and Type 2 diabetes, since he knows that he is a Type 2 diabetic but his doctor forgot to tell him why. For starters, there are 4 major types of diabetes:

• Type 1 Diabetes
- the body fails to produce insulin.

• Type 2 Diabetes
- a condition wherein the body produces insulin but is insufficient and cannot use it properly; we doctors term it as insulin resistance. Most Filipinos have this type of diabetes.

• Gestational Diabetes
- affects pregnant women.

• Pre-Diabetic
- occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes.

The most common symptoms of diabetes that necessitate you to see an endocrinologist or a diabetologist are the following:

• excessive thirst


• extreme hunger


• frequent urination


• unusual weight loss


• easy fatigability


• irritability


• blurring of vision


• wound that does not heal

Currently, there are 6-7 million Filipinos with diabetes (most are type 2), or at risk of the disease (pre-diabetics), with as many who still do not know they have diabetes. Worldwide, there are about 189 million diabetics. The numbers are increasing everyday.

Diabetic ketoacidosis (DKA) and a hyperosmolar hyperglycemic state (HHS) are two of most serious acute metabolic complications of diabetes, even if managed properly by a physician.

Please do not be afraid of the terms. I thought of trying to simplify it, but there is no other way, people --- you simply got to know the real stuff. But don't worry, I'll try to be as gentle as possible.

DKA and HHS can occur in both type 1 and type 2 diabetes. The mortality rate in patients with DKA is less than 5 percent in experienced hospital centers (those that handle numerous cases), whereas the mortality rate of patients with HHS still remains high at ~15 percent. The picture gets ugly for both conditions when the patients are at the extremes of age and in the presence of coma and hypotension (low blood pressure).

The BASIC reason for the DKA and HHS is a reduction in the net effective action of circulating insulin coupled with a concomitant elevation of counterregulatory hormones, like glucagon, catecholamines, cortisol, and growth hormone. These counterregulatory hormones, in turn, lead to increased liver and kidney glucose production and impaired glucose utilization in peripheral tissues, which result in increased blood sugar (hyperglycemia).

Now, here comes the good parts. Pay careful attention to the following diagrams:

In DKA,

insulin deficiency + increased counterregulatory hormones ---->

• release of free fatty acids into the circulation from adipose tissue (lipolysis), and


• unrestrained liver fatty acid oxidation to ketone bodies


• resulting ketonemia and metabolic acidosis

In HHS,

the cause is INADEQUATE plasma insulin concentrations to facilitate glucose utilization by insulin-sensitive tissues.

In both DKA and HHS, there is glycosuria or the previously mentioned "nilalanggam na ihi," with loss of water, sodium, potassium, and other electrolytes. And when your doctor orders a laboratory blood examination from you, he will be able to differentiate if you as a diabetic, is suffering either from DKA or HHS depending on the magnitude of dehydration and degree of ketosis and acidosis produced by your body.

The most common precipitating factor in the development of DKA or HHS is INFECTION. Other precipitating factors include:

• cerebrovascular accident
• alcohol abuse
• pancreatitis
• myocardial infarction
• trauma
• drugs like corticosteroids, thiazides, and sympathomimetic agents (dobutamine and terbutaline)

HHS usually evolves over several days to weeks. In contrast, the evolution of the acute DKA episode in type 1 diabetes or even in type 2 diabetes tends to be much shorter.

Although the symptoms of poorly controlled diabetes may be present for several days, the metabolic alterations typical of ketoacidosis usually evolve within a short time frame usually in less than 24 hours.

As part of the "suspense of being a doctor," the entire symptomatic presentation may evolve or develop more acutely, (and this is the part where we worry) and the patient may present in DKA with no prior clues or symptoms.

For both DKA and HHS, the CLASSICAL CLINICAL PICTURE includes a history of

• frequent urination
• excessive thirst
• extreme hunger
• weight loss
• vomiting
• abdominal pain (only in DKA)
• dehydration
• weakness
• disorientation
• and finally COMA

Physical findings may include poor skin turgor, rapid breathing or hyperventialation (in DKA), rapid heart rate, low blood pressure, alteration in mental status, shock, and ultimately COMA, which is more frequent in HHS.

Up to 25 percent of DKA patients have vomitting, which may be coffee-ground in appearance and positive for blood on laboratory examination.

Endoscopy or the process of inserting a visualizing instrument to see the digestive tract, has related this finding to the presence of HEMORRHAGIC GASTRITIS. I still do not know if endoscopy was done on BongK's mom, but I am assuming her attending physician was exercising good medical judgment when he diagnosed her as having hemorrhagic gastritis.

Mental status can vary from full alertness to profound lethargy or COMA, with the latter more frequent in HHS.

Diabetes is a dreadful disease. It has killed most of my relatives and people I love.

Some of us, like me, like Tito Rolly, like Ting-Aling, probably BongK too, and most of you out there reading this looooong post, have been predestined to have this scourge.

While we cannot escape our fates, we can however, delay the onset of complications by strictly following a healthy code of life, striving to minimize the risks to hasten the process, and hoping we can last long enough to share happiness with our loved ones.

Do you have a diabetic risk? Take this DIABETIC RISK TEST and know where you stand. My score is 6.

US ARMY DOCTORS ABUSED IRAQI PRISONERS?
--- "Do-No-Harm" Becomes A Joke

Dr. Steven Miles, a bioethicist at the University of Minnesota, just wrote in the Thursday issue of the medical journal LANCET that some American army doctors in Iraq and Afghanistan betrayed their duty to patients by participating in and covering up the abuse of prisoners.

Among the allegations cited by Dr. Miles are the following:

• "Confirmed or reliably reported abuses of detainees in Iraq and Afghanistan include beatings, burns, shocks, bodily suspensions, asphyxia, threats against detainees and their relatives, sexual humiliation, isolation, prolonged hooding and shackling, and exposure to heat, cold and loud noise."


• "Government documents show that the US military medical system failed to protect detainees' human rights, sometimes collaborated with interrogators or abusive guards, and failed to properly report injuries or deaths caused by beatings."


• "In one example, soldiers tied a beaten detainee at the top of his cell door and gagged him. The death certificate indicated that he died of 'natural causes...during his sleep'. After news media coverage, the Pentagon revised the certificate to say that the death was a 'homicide'." [BBC NEWS]

The Miles article was also accompanied by a LANCET editorial which said:

"Guidelines and codes of practice state that doctors, even in military forces, must first and foremost be concerned about their patients and bound by principles of medical ethics.

"Health care workers should now break their silence. Those who were involved in or witnessed ill-treatment need to give a full and accurate account of events at Abu Ghraib and Guantanamo Bay." [BBC News]

Will these US military doctors break their silence? Or are they under a threat not to spill the beans?

These days, it is difficult to become a doctor. Especially when you are accused of being a part of a monstrosity that, I wish to think, they did not want to participate in, in the first place.

This reminds me of the stories my old relatives used to tell me during the time that they experienced the Japanese occupation here in the Philippines. In a time of war, most of the sanity of the participants --- soldiers, medical personnel, even the war victims --- seem to evaporate like water in a barren desert.

All hell breaks lose afterwards.

Until somebody sings and we become aware....but by then, it might be too late. We can not bring back the dead to life anymore, and any emotional scar inflicted will forever be etched in the minds of the victims.

TO SMILE AGAIN
--- Cleft Lip and Cleft Palate Update

The possibility that their child might be born with an anatomic malformation remains to be one of the most common worries of expectant parents. A rich interplay of random genetic and environmental factors play major roles in the development of anatomic malformations.

Among the anatomic malformations, cleft lip with or without cleft palate, is certainly one of the most common birth defects observed. At one point or another, you must have encountered someone who is bingot (that's the term we use in Batangas) and who speaks like a ngongo (pertains to the garbled nasal intonation of cleft lip/palate patients). Just like any handicap, it is sad sometimes when said deformities are made as objects of jokes and amusement among those who don't know any better. How many times has our local cinema made this as a subject of their comedy stunts?

The incidence of cleft lip with or without cleft palate varies among ethnic groups:

• Native Americans or Amerindians - 3.6 per 1,000 live births


• Asians - 2.0 per 1,000 live births, with the Philippines having it at 1.94 per 1,000 live births


• Indians - 1.5 per 1,000 live births


• European ancestry - 1.0 per 1,000 live births


• Africans - 0.3 per 1,000 live births

Genderwise, cleft lip with or without cleft palate is more frequent among boys, while isolated cleft palate is twice as common among girls. [NEJM -- August 19 Issue][WHO Oral Health Programme]

What causes cleft lip with or without cleft palate?

In this day and age, little is still known as to the specific cause of this condition. The usual medical answer will be the one I gave above which is genetic.

From 4 to 12 weeks of gestation (first 3 months of pregnancy), the upper lip and palate develop from tissues lying on either side of the tongue. As the face and skull are of the baby are formed, these tissues should grow towards each other and join up in the middle. When the tissues that form the upper lip fail to join up in the middle of the face, a gap occurs in the lip. if a single gap occurs below one or other nostril, it is termed a unilateral cleft lip, and when there are two gaps in the upper lip, each below a nostril, it is called a bilateral cleft lip, as shown in the picture below.

From the British United Provident Association (BUPA)
In cleft palates, the palate fails to join up and a gap is left in the roof of the mouth up into the nose.

This failure of the "joining-up process" is attributable to a genetic factor often traced in the child's family history. The latest issue of the New England Journal of Medicine carries an excellent medical study on a specific mutation of genes involved in the autosomal dominant form of cleft lip and palate, also known as Van der Woude's syndrome. The researchers were able to identify the gene that encodes for interferon regulatory factor6, also called IRF6.

Rather than bore you with fancy medical details, it is enough for you to know that their study is significant because this presents us with the possibility of predicting whether some parents are more likely than others to have a second child with the "isolated" form of cleft lip and palate (Van der Woude's Syndrome). Through genetic counselling, it will now be possible to surgically treat possible cleft lip and cleft palate patients at an earlier stage.

Certain types of drugs like phenytoin and sodium valproate (anticonvulsants), benzodiazepines like diazepam, and corticosteroids have been associated and may increase the risk of cleft lip and cleft palate incidence, especially if said medications were taken during the first 3 months of pregnancy. As always, this emphasizes once more the importance of consulting your respective obstetricians when you are pregnant.

Diagnostically, a cleft in the fetal lip may be visualized with the use of transvaginal ultrasonography as early as 11 weeks of gestation or the 3rd month of pregnacy and by means of transabdominal ultrasonography as early as 16 weeks or the 4th month of pregnancy. The graphic below courtesy of Dr. Beryl Benacerraf and the New England Journal of Medicine illustrates this:

A three-dimensional ultrasonograph (PanelA) reveals bilateral cleft lip at 22 weeks of gestation. Panel B shows an infant with bilateral complete cleft lip and palate, and Panel C shows the same child at 18 months of age, after synchronous nasolabial repair and palatal closure (performed at a second stage)

In the weekly Perspectives of the NEJM, Dr.John B. Mulliken of Boston notes that humanitarian surgical missions from wealthy countries like Interplast, Operation Smile, and the Smile Train are "the objects of both praise and derision."

Praise, I can relate to but when he mentioned "derision," I was amazed as to why. Like most, I thought these surgical missions are considered heroes and saviors in whatever part of the country they go to --- be it Cebu, Davao, Bacolod, or right here in my very neigborhood of Metro Manila. He explained his reason:

"Many of these missions emphasize head counts --- the number of clefts repaired per trip. Often, there is little effort to involve local surgeons, who are left to manage postoperative problems once the visitors have departed. Some physicians in the host countries consider these expeditions to be "surgical safaris." Usually, there is NO continuity of care. These children need help with speech, dental and orthodontic services, and often secondary surgical procedures, and they must be followed until their facial growth is complete.

Many of these humanitarian organizations are currently in transition. It is no longer acceptable to send a team composed of junior residents or practicing plastic surgeons who are not actively involved in cleft care at home. There has been a major shift toward educating the local cleft-care teams, either through direct supervision or by financing visits to cleft-care centers in the United States. This change in philosophy led to the establishment of the Smile Train (headquartered in New York), and now a few other groups are coming on board with the same concept." [NEJM]

I agree with him.

Even in surgical missions, the concept of don't-just-give-them-fish-but-teach-them-how-to-fish is still best.

Lastly, I saw the picture below in one of the humanitarian organizations' website, and I am glad to note that even with the difficulties brought about by the cleft lip and cleft palate deformities to parents and children alike, the possibility of making these patients happy and be able to smile again is no longer that remote.

From OPERATION SMILE

THE COUGH THAT WON'T GO AWAY
Persistent, Irksome and Recurrent

"Tumatahol ka na naman" (You're barking again).

Such is the amusing analogy and banter elicited when you run across one poor unlucky fellow who incessantly coughs. Likened to a dog who never stops barking, somebody who coughs uncontrollably is usually the object of attention in office, school, or wherever you might find them. And I believe not a day passes that you will be spared from such an encounter.

Especially these days.

From a doctor's point of view, cough and its persistence, remains to be one of the most common complaints encountered in medical practice. Causes usually fall into one of these (not necessarily arranged in order, ok?):

• Asthma


• Sinusitis


• Allergic Rhinitis


• Chronic Bronchitis


• Influenza
and last, but certainly the most feared of all,

• Pulmonary Tuberculosis (PTB)

While PTB is really dreadful, I believe its incidence is strongly dependent on our immunities and the quality of air we are subjected to everyday. That is what I will be posting about today.

Last July 27, the Environmental Management Bureau (EMB) of the Department of Environment and Natural Resources (DENR) said that

"The quality of air we breathe in Metro Manila and some parts of adjacent provinces is within the policy standards that safeguards human health and the environment. The EMB cited data gathered by 8 monitoring stations that evaluated the air content for major pollutants like sulfur dioxide, nitrogen dioxide, photochemical oxidant, carbon monoxide and suspended particles. Results 'did not exceed' the guidelines for 'ambient air quality' as set by the Clean Air Act the EMB happily declared." [INQ7.net]

Are we supposed to believe that? Who are these illusionists kidding?

That particular news report prompted friend blogger Julsitos of the Idiot Board to post "Boogerama," in an effort to tell those DENR "magicians" that "Hey fellahs, check your built-in indicators --- your boogers --- and tell me again what the quality of air is!"

Indeed, you can even ask Sassy, who lives on a house on a hill (Antipolo City), how the skyline looks on a clear day for the rest of us here in Metro Manila. Surely, she will tell you that a gray, hazy smog floats and envelopes our skies. This gray haze has already been given a term by some 200 UN-sponsored scientists two years ago: they called it the "Asian Brown Cloud" phenomenon.

The Asian Brown Cloud phenomenon, "estimated to be 2 miles (3 kilometers) thick, is responsible for hundreds of thousands of deaths a year from respiratory disease. By slashing the sunlight that reaches the ground by 10 to 15 percent, the choking smog has also altered the region's climate, cooling the ground while heating the atmosphere, scientists said. The scientists warned that the thick cloud puts the lives of millions of people at risk from drought and flooding, partly because rainfall patterns have been radically altered with dire implications for economic growth and health." [COPD International Library]

Metro Manila residents are exposed to more than 100,000 tons of particulate matter annually. Since the enactment of the Clean Air Act (CAA) of 1999 and the elimination of lead in gasoline beginning January 2001, there is notable improvement made in that ambient environmental pollutant levels are down.

There is improvement alright, but to say they are within "acceptable levels," is a delusion.

And deluding your fellow Filipinos is not really in our best interests, right?

The sad facts remain:

• "Industries, most of which are located in the Metro Manila airshed, contribute a lot to air pollution. They include thermal power stations, cement manufacturing plants and oil refineries. Oil and coal-fired power plants, many of which are also located in the metropolis, emit 223,000 metric tons of sulfur dioxide every year."



• "Diesel emissions from buses, jeepneys, utility vehicles and trucks are estimated to be the biggest contributor to urban air pollution. Last year, there were 4.2 million registered vehicles in the country, a more than threefold increase from 1.2 million in 1983. A fast growth in vehicle ownership is contributing significantly to air pollution."



• "The health cost of air pollution in the 4 major cities of the country has been estimated to be more than $400 million (about P22.4 billion) a year or approximately 0.6 percent of the country's gross domestic product (GDP). It has been estimated that more than 2,000 people die prematurely every year because of air pollution. More than 9,000 people suffer from acute bronchitis. And nearly 51 million 'respiratory-symptom days' are recorded yearly in Metro Manila."
[INQ7.net]

The DENR can always argue that their monitors record that metropolitan air quality is within "acceptable levels." Sure, they can do that. They can even call press conferences ( as they did) to trumpet that assertion.

But is it credible?

They present us with number and figures, while we cough, cough, and cough!

ON STALE VACCINES
Truth or Rumor?

"Murmurs in the medical community are growing too loud for health officials to ignore. A big pharmaceutical firm supposedly has distributed stale vaccines which were then injected by unsuspecting doctors to children and adults. The firm, which manufactures the drug for two multinationals, is trying to keep it hush-hush. Its warehouse temperature detector had conked out late last month, freezing and ruining the vaccines. It did not act on the matter until the two multinationals issued advisories to internists and pediatricians about the snafu. By which time, it was too late.

The drug maker claims that the stale vaccines were safe, just that they lost efficacy. That didn't wash, however, with concerned doctors who believe that patients may have been put at risk. The two clients have ordered the firm to recall all the damaged stocks, a sign that something is amiss. Only then did the maker pull out the product from hospitals and drugstores, with promises to replace them soon. To this day, there has been no report if all the damaged vials have been destroyed. Health authorities likewise have made no report on potential health risks to hapless patients." [Stale vaccines still in use? --- Philstar.com]

What is it with this unnamed "big pharmaceutical firm?" It recalled the alleged stale vaccines AFTER its 2 multinational clents ordered it to do so?

Anu ba naman yan?!? Kailangan pang sabihan bago gawin ang tamang gawin? (What's this?!? It was still necessary that they had to be told or "ordered" before doing the responsible thing?)

AAAARRRGGGH.

What was that all about? Was the firm afraid of lost sales? Was it more concerned with lost sales than being a responsible pharmaceutical company?

Health services are delicate and necessitate both maturity and the ability to be responsible. Vaccines usually concern children. They are expensive and yet parents always consider them necessary for their kid's well-being. I think a single vaccine administration --- say, measles or DPT at a pediatrician's clinic costs about a thousand a pop --- and if you're a mom who discover that your child has just been administered a stale vaccine, wouldn't your temperature and BP rise in anger?

In this case, pediatricians and internists are likewise victims, but they are made accessories to this snafu. Ginagawa silang tanga. (They are made fools).

Sure, sure, I buy the argument that a temperature detector conking out might produce only a "lost efficacy" on the vaccines concerned, but....? I mean, that's it? Wouldn't you at least have the balls to publish full-page apologies and advisories in leading dailies? And why is the Department of Health (DOH) so silent about it? Hello! Hello! Oks lang kayo?

Ano ba ito --- katangahan?!? Hanggang dito ba naman, maglolokohan pa tayo?

I feel so frustrated with this childish concept of "if-you-can-get away-with-it-why-bother?"

GRRRRR!

____________________________

UPDATE: My friend Ting-Aling is now in the Blogosphere. She started blogging hours ago. Please check out her weblog by clicking the link below:

Ting Aling's SERENDIPITY Weblog

ARE WE AT THE "EDGE OF THE PRECIPICE?"
If So, How Long Can We Hold on?

And I thought yesterday's post was bad.

I mean, if Filipino doctors really become endangered species soon, I see our nation's fate turning for the worse. Filipinos can probably survive without too many clothes or without shelter (surely our extended family culture can save us), but getting afflicted with either a deadly infectious disease --- which are a dime a dozen here --- or a long-standing chronic illness like diabetes, chances of long-term survival decreases to a minimum. Confound this with equally depressing conditions like expensive medicines and hospitalizations and I think we have just concocted the recipe for our doom.

Pardon me, if I'll go whining again. It seems that's what I do best.

I thought this morning would be better, but as I came across Conrado de Quiros' "Edge of the Precipice", nanghina ako (I felt weak). Read his article below and weep.

Edge of the precipice - INQ7.net
What I cannot fathom is the inaction that goes along with it. I'm pretty sure the President and her crew know about this. I mean, de Quiros is not from the government, but he writes about our current state too well it has the significant details all over it.

You know about these things. I know about these things. WE ALL KNOW what's happening.

And....? Wala. Dedma. The inaction and the silence is deafening. Of course, I and the others can blog about these things until kingdom come but who do we expect will help us?

George Bush Jr? Far-out. After Angelo, he called it quits.

Keana Reeves?

Last I heard, she has changed her mind about naming names in Congress. You might think of her as an inane character, and maybe she is. But she exemplifies a Filipino trait that's missing all this time: sustainability

I do not believe we lack the traits to bounce back where we should be. We lack the DRIVE TO SUSTAIN the good things we are doing. Again, the causes for these are legion: cynicism, poverty, selfishness, corruption, declining quality of education, etc., etc.

I do not pretend to know the answers to all our problems. Even if I did, it would be too foolish of me to think I can do anything substantial.

I am just worried. Make that --- very worried.

Because if a lowly columnist says we are on the "edge of the precipice," I believe him. I can smell and taste it everytime I wake up. I believe you do, too.

I think President GMA has pushed the panic button before she even delivered her State of the Nation Address (SONA) in Congress.

Have you witnessed the SWARM of taxes getting implemented everyday? Tax the text messaging service. Tax the motels. Tax liposuction and other surgical enhancements. Tax left and right. GMA is streamlining the bureaucracy by laying off government workers and uniting redundant government departments in an effort to save more money. She is also trying to sell portions of the Malampaya consortium, which by the way, I believe is our remaining ace in bad deck of cards. You might opine that these are good moves but they are simply NOT ENOUGH. Because meanwhile, have you noticed that gas prices increased yesterday? Prices of basic goods have gone up, too.

Ghoulish scenarios keep playing in my mind: the economic status will continue to plummet in the coming months and more and more doctors, nurses, teachers, engineers, and truck drivers will go to the US and Iraq in the hope of greener pastures.

Wala nang matitira dito para mangalaga sa mga nangangailangan. Wala na ang mga "rocket scientists ni Tito Rolly. (No one will be left here. Tito Rolly's rocket scientists will all vanish)

Let us try our best NOT TO FALL OFF as we hang on "the edge of the precipice," ok?

DOCTORS IN EXODUS
"Critical" Physician Shortage By 2010

In today's issue of the Philippine Daily Inquirer, Belinda Olivares-Cunanan writes in her column that there will be a "critical shortage of Filipino physicians by the year 2010." She gathered this while interviewing Dr. Josefina Almonte, chair of the Department of Surgery of the Philippine General Hospital (PGH) during her Sunday radio night program. Excerpts are as follows:

• "The Philippine medical profession here is in serious peril of losing its doctors, as many of them go to the United States to work as nurses because of the easy recruitment and the much bigger pay abroad
."


• "Senior medical residents here earn about P7,000 to P8,000 a month, whereas in the United States, as nurses, they can easily earn $26 an hour." Converted that's approximately P1,456 per hour or P11,648 per 8-hour nursing duty period. A Filipino doctor-turned-nurse in the US easily earns close to P300,000 a month. Geeez, you can already buy a decent second hand car with that amount. No wonder they are flying like birds to the US.



• "Almonte said that enrollment in medical schools here has dropped in recent years because of this situation, and in fact, a recent Department of Health study showed that if the exodus of our physicians is not arrested, the country will be experiencing a critical shortage of about 18,000 doctors by 2010."



• "Southern Leyte Governor Rosette Lerias' alarm over the fact that 13 of the 15 doctors in her province's Integrated Hospital Office are taking up nursing courses on the side, preparatory to leaving for the United States."



• Chief of hospitals Dr. Leonardo Eway admitted, too, that three district hospitals in the province (Leyte) need about 15 doctors, 'but sad to admit, there are no takers'."



• "Governor Lerias was quoted as saying she would appeal to the doctors to value service to the people more than the potential of earning more money in the US."

[Critical shortage of doctors by 2010 - INQ7.net ]

Can you imagine a world with a critical shortage of doctors? I can. Can you imagine the possible scenarios? Forgive my pessimism but here's what I think:

• Massive infirmities and deaths in the rural areas.



• Strong possibility of epidemic outbreaks with no one competent enough to control them.



• Crowding of hospitals here in the metropolis because there are no more health professionals in the rural areas. Patients will come here in droves!

Is it all about money? Is that the reason why these doctors leave to become nurses abroad?

YES.

Can we or the government appeal to them to "value service to the people more than the potential of earning more money?"

IN YOUR DREAMS. Hah! You can appeal all you can but they can't be stopped. Not unless the government will start caring for them and for what they do.

Can't they sacrifice?

HAVEN'T THEY SACRIFICED ENOUGH? They did. They gave the government a chance to deliver the promises they made. Apparently, doctor and nurse salaries are still better somewhere else not here. Meanwhile, prices of goods, tuition fees, and fuel continue to rocket upwards.

There is an old Chinese proverb that I often use as my guide in healing. It says:

"An excellent doctor heals an ailment by preventing factors leading to the disease, while a mediocre doctor (almost always) heals the full-blown disease."

If the government was a doctor in this case, what kind of doctor do you think it is?

Excellent or mediocre?

Only time will tell.

FLORIDA NEWS
--- A 480-Pound Woman, Hurricane Charley, and Weather-Talk

It's odd Sunday. Bloghopping today, I came across Amanda Doerty's Blog that talked about a 480-pound Martin County woman in Stuart, Florida who died after emergency paramedics tried removing her from a couch where she had stayed for about --- don't be shocked --- six, long years! The paramedics reported that Gayle Laverne Grinds, the 40-year old 480-pounder died last Wednesday from complications arising from "morbid obesity." Complete story from WFTV.com-Florida.

Morbid obesity happens when you have a BMI value greater than 39 or 100 pounds more than your ideal body weight (IBW). Some of the known causes are, of course, an increased caloric intake, no physical activity, and thyroid gland problems. Complications are varied and you can already guess them: diabetes, heart disease, stroke, hypertension, breast and colon cancers, and to a lesser extent depression, osteorthritis, and chronic arthritis. I'm quite sure Ms. Grinds died from one or two of the first 4 complications.

Patients with morbid obesity are usually advised to undergo a strict weight reduction program that needs strong support from relatives of the patient. More often than not, these patients are also advised to undergo bariatric surgery in order to limit their caloric intake. It is estimated that about 4 million Americans are morbidly obese. In the case of Ms. Grinds, her live-in partner Herman Thomas seemed incapable of helping her deal with the problem. The situation was so bad that after six years of immobility, Grinds' skin "had grown into the fabric of the couch," as Amanda's blog put it.

In other blogging news, Blogger featured Candie Goodyear, a 21-year old American woman who blogs in detail about Hurricane Charley as it roared and rampaged most of Florida's southwest coast. Read her posts about Hurricane Charley. It offers a first person account of the situation. Latest reports said the hurricane left 13 people dead and billions of dollars in damages.

In the Philippines, we may not have hurricanes, but tropical depressions and typhoons are ordinary news especially in these months. Catastrophic damages like deaths, destroyed houses and property, and floods are not new to us. We even have a tropical cyclone website. In times of disaster the rural folk in the provinces are the ones usually affected. Health personnel are especially busy tending to cases which range from flu to leptospirosis, also known as Weil's Disease in the US, and is usually due to frequent unavoidable wading in dirty floodwaters.

I am equally fascinated and impressed by how most westerners are so informed about their weather conditions. Here, the weather isn't usually predicted accurately by our (inappropriately termed) weather bureau, the PAGASA, which by the way, is also a Pilipino Tagalog word meaning hope. Alas, there is nothing to hope for with some of PAGASA's forecasts: if they say it will rain, the sun usually burns bright and if they say it will be sunny, chances are it will rain. Lack of funds usually explain PAGASA's inaccuracies and they could not really be blamed totally. I am just flummoxed most of the time because had the bright guys in government spent more time thinking, they would have known that a lot of money and lives could be saved if we had a more sophisticated way of forecasting the weather.

Enough of that, I'm already ruining your Sunday.

SALMON BLUES AND OTHER BLUES
--- Bad News For My Favorite Fish

I like salmon. No, I'm lying. I love salmon.

Since November 1992 when I came across an informative article in the Circulation medical journal recommending the consumption of fish to prevent heart disease, I have always seen to it that I "consume two fish meals per week, with an emphasis on fatty fish (ie, salmon, herring, and mackerel)," as recommended both by the Philippine and American Heart Associations (PHA and AHA, respectively). That same article also said that "commercially prepared fried fish (eg, from restaurants and fast food establishments, as well as many frozen, convenience-type fried fish products) should be avoided because they are low in omega-3 and high in trans-fatty acids."

That began my love affair with salmon. I eat it cooked (sinigang, a Filipino favorite), or raw (in sushi or sashimi, Japanese). The taste is heavenly. I have never looked back and I enjoy it weekly. I also give it free publicity by recommending it to my patients.

Now comes this bad news that reveal a scientific study showing alarming "contamination levels of Polychlorinated Diphenyl Ether (PBDE) in farmed and wild salmon," and that highest levels are from European salmon farms, with Scottish farmed salmon having the second highest level. PBDE, a widely-used flame retardant, is a bio-accululative chemical contaminant, meaning the body does not break it down. While in the body it can exert deleterious hormonal and hepatic (liver) effects. [Scotsman.com News - Latest News - Warning after Toxic Chemicals Found in Salmon] Early this year, salmon also got bad rep when an extensive study (by the same people) identified significant levels of polychlorinated biphenyls (PCBs) in farmed salmon.

Another alarming finding is that

"these potential carcinogens are showing up where we should least want to find them, in wild salmon caught off the Oregon and British Columbia coasts.

"The casual response might be simply to not eat fish, which Americans in general do not eat often anyway despite the health benefits of long-chain omega-3 fatty acids that cannot be derived from non-marine sources.

"But further inquiry shows us that traces of PBDEs also are found in milk, beef and other far more staple parts of the American diet.

"In November of last year, the journal Environmental Health Perspectives detailed the presence of PBDEs in the most vital meal in the human diet: breast milk.

"There is no adequate substitute for breast-feeding an infant, and the health benefits of eating fish are well documented. Discouraging those practices likely would increase malnutrition, especially in poor and minority communities that have less access to alternatives." [Seattle Post Intelligencer]

Salmon, beef, milk, and even breastmilk contaminated with potential and established carcinogens? What's next?

As a doctor, I caution patients from consuming too much fat from beef and pork products, but I assure them that it isn't that bad at all because there are healthier alternatives like chicken and fish. But when I hear bad news like this, I become sad and frustrated.

It's like implying that if you do not die of heart disease or stroke or diabetes, surely cancer will get you.

Surely, that is not how it should be. People must really be taught to take care of this planet and the environment. Pollution limits our choices to none.

HOW TO GET FAT
Eat Plenty of Carbs and Don't Exercise

The latest issue of National Geographic has nice articles about getting fat. Thanks to friend BatJay for the reference. It says there are two fat laws:

First Law of Fat - anything you eat beyond your immediate need for energy, from avocados to ziti, converts to fat.

Second Law of Fat - the line between being in and out of energy balance is slight.

["Why Are We So Fat?" -- National Geographic ]

The first law is self-explanatory. The second one emphasizes that the tendency to overeat is always there. So, the real key is to pay careful attention to what you eat, how much you eat, and how much you exercise.

Getting fit is really simple math. Keep a food and exercise diary. Know first what your daily caloric intake should be. This is usually based on your daily energy expenditure. An athlete should eat differently from an office worker. Obesity problems arise when the office worker eats like an athlete. If you want more information, click here.

You can also do what this man is doing. However, if you have chronic conditions like heart problems and diabetes, it is best to consult your doctor first before engaging in any diet activity. Not all diet and exercise programs can be done by any person.

Over the years, getting fat has never been this easy and simple. Whereas early man had to move around to hunt and gather his daily caloric intake, modern man can sit on his couch, call for pizza and burger delivery, while he sits and enjoys a favorite show on TV. Progress and modernity made it possible for modern man to make his food get to him while he relaxes.

Also, food portions now have grown in size compared to say, 40-50 years ago. Eat-all-you-can is the message driven to most consumers by almost all fastfood outlets. Vulnerable and yielding to this doctrine are children, adolescents and most adults all over the world, who are consuming more than what they should be eating daily. The easy life has also brought about dread for physical activity.

Hence, the combination of eating the wrong food items and no exercise has contributed much to the obesity crisis no one wants. And since obesity is a contributing factor to diseases like diabetes, hypertension, stroke and heart problems, we are also observing an increase in morbidity and mortality rates.

THE FOOD PYRAMID UPGRADE
Rising Obesity Rates Force Its Revision

Because of rising obesity rates, the American food pyramid is getting a major revision.

The 13-member federal advisory panel task to review and revise the Dietary Guidelines for Americans held its final meeting yesterday in Washington. It seeks to propose changes in its current nutrition recommendations. The San Francisco Chronicle reports that when the food pyramid was issued in 1992, "no state reported obesity rates above 20 percent." But ten years later, 29 states had obesity rates of at least 20 percent. The US Department of Agriculture admits that while almost 80 percent of Americans recognize the pyramid, only 2 to 4 percent eat according to it. [San Francisco Chronicle]

Among the NEW recommendations are:

• Eat whole grain products rather than refined grains to reduce risks of heart disease and other conditions.



• Fruit and vegetable servings would be expanded to 5 to 13, from the current 5 to 9 daily servings.



• Avoid trans fats, and reduce total daily salt to 2,300 milligrams. If you do not know what trans fats are, click here and here.



• Plan and control daily caloric intake. If you want tips, see this menu planner, and plan your meals based on your daily energy expenditures.



• People should engage in at least 30 minutes of moderate activity on most days and to possibly double that if they want to lose weight.

There is almost nothing new in these recommendations. I think I have blogged about some of these in the past few months. If we just eat the right food items and exercise moderately each day, getting overweight can be minimized.

I'm pretty sure the nutrition guys here will follow the same guidelines implemented by their US counterparts. Overweight and obesity problems are no longer adult problems. They are also affecting most children and adolescents.

Next time you go to KFC where they have unlimited gravy, or feast on McDo fries, think about what I posted today, and decide what you really want for your body.

CAN THE PHILIPPINES REBOUND?
Or Should We All Begin Taking Antidepressants?

In the face of rising oil prices, tax on text, a nuclear plant getting converted to a natural gas plant, Sen. Joker Arroyo's "tax terrorists," a huge budget deficit, an impending power shortage, and other news that bring nothing but depression, I came across a Peter Wallace special report written before the May elections that tried to analyze and digest the Philippine situation in a capsule. Excerpts below:

In the past 25 years the Philippines has averaged 3.1 percent annual GDP growth, with a population growth of 2.5 percent. Which means almost no improvement for the Filipino over that 25 years. This is about half, or less, the rate achieved by other nations in Asia.

Peter Wallace Special Report

Why?

1. Politics - vested interests vs national good

2. Uncontrolled population growth

3. Weak educational system

4. Corruption

5. Inadequate infrastructure

6. An agriculture system that hasn't improved in 25 years

7. An inadequate focus on job creation

8. A judiciary in need of major improvement

9. Security

If these 9, and it must be all 9 of them, aren't fixed the Philippines will average 3.1% for the next 25 years too.

At its present rate of growth of the population (2.36 percent), and the economy (3 percent) it will take 30 years to catch up to where Thailand is today.

25 years ago it was ahead of Thailand. 40 years ago it was second to Japan.

Mr. James Fallows was right. This is a damaged culture. It is a selfish culture where too many think only of themselves (and family) and care little for others, or the nation as a whole.

I cannot emphasize too strongly that without absolutely fundamental change in these 9 issues, and the cultural change to go with it, the Philippines will be the basket case of Asia one generation from now.

It will not change if the culture, the attitude (of the leaders) does not change.

It will not be easy, it will not be popular, it will need a skillful balancing act between pandering to politicians, generating public support and effecting major reform. Great leaders were so because they had a long-term vision and gambled their careers to achieve it. [Peter Wallace Special Report --- "DOES THE PHILIPPINES HAVE A CHANCE?"]

I suggest you read the full article by clicking the link above.

I do not know why politicians are dying to become the President, the Senators and Representatives of this nation. With all these problems, I do not think its cool to be the designated problem-solver(s) of a nation with a "damaged and selfish culture."

The first step to development is weeding out the bad guys. That I think is the solution. At the same time, I also think it is the most difficult.

We have ran out of "great leaders."

Leaders come and go, but the problems remain and get worse. Present leaders do not know what sacrifice and discipline mean, anymore. Nobody resigns anymore because of delicadeza. They know more about politics, kick-backs, spin-offs, good speeches, and less on principles that work.

Now, each Filipino cares only for himself and his immediate family. Beyond that, he does not give a s**t. Majority of them want to get out of this country. Almost everyone I talk to wants to become a nurse. Not here. In the US or some European country, that's where! There are no jobs for them here and they would rather get kidnapped --- beheaded even --- in a foreign land than die of frustration here.

As a health professional, I even want to add a #1O to the list above: a health system in crisis as exemplified by

• a very expensive health care setup - majority cannot afford decent hospital care and high-priced medicines


• a senior citizen law that is ignored by most drug pharmacies.
  
  
• a nursing crisis that will soon deplete our country of health professionals

Please tell me if I am wrong.

Please tell me I am wrong.

Please tell me we can get out of this muck.