CANCER IN A 6 MONTH PREGNANT

I am used to facing dilemmas in my practice. But the most perplexing case I had was with a 35 yr old female who was at the same time 6 month old  pregnant stage 4 with an oozing wound on the breast. What do you do? You end the pregnancy and do radiotherapy or chemotherapy? Or you go ahead do the modalities without batting an eyelash on the baby in uteru. Prolifers would squirm with this idea. In terms of treatment it is out of the question. A stage 4 breast cancer with metastasis all over the body has a few months to live. But we have to provide pain relief. Drugs like oxycontine and morphine will provide relief. But these are very toxic to the baby causing a lot of damage . I presented this case to the GYNECOLOGISTS and they opted for caesarean section to bring out the baby and give him a chance to live. As of me, I cannot do anything for the breast cancer. Surgery is out of the question because breast cancers are noted to bleed profusely even without stopping. The patient went into pulmonary edema and died before any intervention could be done. The baby died in uteru because the patient and relatives would not agree to any caesarean section.

literate self-medication

I am always appalled by illnesses resulting from self medication. I have seen a lot of complications resulting to self-treatment that I have been thinking of ways to teach people how to self medicate. We cannot force people to go to medical school before treating themselves. And there is no way a non-medical person could ever teach how to treat illnesses. Most  people would only relate what they have taken and experienced. And these  do not apply to any body else but themselves. I am coming up with this idea on a website  where you can ask questions what to do with your illness similar to a second opinion. ( inhousedoctor.com.ph). It is still in its construction stage and we will feature a lot of ways of self treatment

little knowledge is a dangerous thing

Not really a hype, but the scare of kidney side effects of medicine is well known. Because of this I have seen a lot of patients succumb to a more serious disease like stroke when anti-hypertensive medicines are stop without medical consultation; heart attack when vasodilators are suddenly discontinued at the behest of relatives and neighbors; flaring up of infection because antibiotics were suddenly discontinued and changed to herbal supplements. It is true that to have to read medical articles and opinions in newspapers, internet and magazines. But you have to consult a physician for any changes in your drug regimen. You did not have the education and you will never know how to treat yourself or other people. Stop giving advice for treatment. You don't have an iota of knowledge of what you are saying. Leave it to the professionals.

KELOID

Keloid scars are horrible to see. They are so disfiguring and ugly to look at. And yet, it is so common. A small injury to the chest and it enlarges to a very big hard bridge of a tissue. When surgically removed, they occupy the line of incision and becomes larger and uglier. There is no other resort but to inject steroids subcutaneously with local anesthesia. The success rate is about 35% after a 6 monthly injection. but the side effects are horrendous; buffalo hump, rounded face, brittle bones in old patients,etc. but some patients would rather have the side effects than to have this kind of scar.

old age

With our sophisticated technology and cosmetics, we don't have a reason why we don't use them to prevent appearing our age. Some people insist on appearing old despite the fact that there is no advantage in that. Yes, in some countries they still respect old people. But in most cities, old men and women are pushed aside. Now, if you groom yourself to a younger look, you  get a lot of boost from the people around you and from yourself. When you look at yourself and find yourself wonderful, you release a lot of good endorphines which are good to your heart, lungs, kidneys , brain and liver not counting sex stamina and psychological goodness.

Taking health into your own hands

A small skin tag was noticed by the patient on her chest. It was not bothering her but because she was beauty conscious, she cut it with a nail cutter.  It bled profusely but eventually stopped. In the next few days, an ugly mass started to protrude and formed where the skin tag was. And this is the result . I surgically removed it and found the base was so big for a nail cutter to cut.

MAJOR OR MINOR SURGERY

MAJOR SURGERY OR MINOR?

A lot of you do not know why an illness needs major surgery and another is a minor surgery. Probably you think it has got to do with money. NO sir. Surgical cases are categorized as minor or major depending on the difficulty of the procedure, the need to anesthetitize ( whether general anesthesia or local anesthesia), the need for assistant surgeons and nurses, the complication of the procedure and instruments to be used.

Acute Appendicitis cannot be done in the clinic as in excision of cyst of the breast because the procedure entails opening of the abdomen, pulling out a portion of the intestine ( which is painful), using spinal anesthesia and the need for the patient to stay in the hospital to recover from the surgery.  If medicine can come up with a procedure wherein we can send the patient home after surgery for Acute Appendicitis, this illness will become a minor thing.

Many surgical procedures can become a minor procedure if we can send the patient home as soon as it is finished. Few years from now, gall bladder surgery could become a minor surgery since our postoperative recovery period is becoming shorter and shorter. Twenty years from now, probably, we can do heart surgery in the morning and the patient can go home in the afternoon.

We used to have patients who had been operated for goiter to stay in the hospital for a month or two. Back in the sixties, I still can remember my relatives who stay in the hospital for months because of an illness especially when it entails surgery.

There are some surgical procedures today that could easily become clinic procedures  in the future.

Herniorrhapy or the surgery for hernia is one. Since the procedure is only repair of the abdominal wall defect, this can easily be done in the clinic if we can instill anesthesia lesser than spinal.

Another is hemorrhoidectomy or the surgery for the almoranas. I have done some in the clinic but they were the small ones not those who are as big as the tomato. The problem with the big ones is that they bleed profusely and if done outside of the operating room, the procedure is very scary.  The amount of anesthesia is so great that the possibility of cardiac arrest is there.

We surgeons always think of doing a cheaper surgery. If we can spare the patient of so much expense, we will do the procedure in the clinic if it can be done without risk

INSTANT RECALL

INSTANT RECALL

With the bulk of patients I see, I often find myself wondering which patient has this and which patient has that especially when I meet them in Malls or streets. Nowadays, I do not encounter people seeking consultation in the streets unlike few years back. It is probably because people have learned that it is dangerous to consult a doctor in the middle of the aisles of groceries and Malls; between the cans of sardines and tissue paper ( you know, the mind set of the doctor is the name  of the corned beef he is about to purchase and so, he might unintentionally prescribe it).
The bigger problem I have is to recall what I did for this patient or that patient a few years ago. People recall incidents if they are traumatic, exciting, romantic and money making. Otherwise, you forget about it in sixty seconds flat. We doctors remember all the things we did on a patient but forget his name. We can recall what part of the hospital you were admitted; what particular bed; what medicines; but not your face. Much more the relatives. People expect us to remember the cousins, the nephews, the neighbor, the kumpadre.

I had the unfortunate experience of forgetting the wife of my anesthesiologist.  But that was forgivable because though I see him  almost everyday in the operating room, I have not seen the wife  for many years. But forgetting one’s patient is sometimes a dilemma. Do you feign surprise or forgetful? It takes a few seconds ( long after the person is gone) before I could connect the present to the past. I often joke to my friends that if someone would sell my brain it would be cheap and bargain because it is over used.

But the findings of Science now is that the more you use your brain, the more it builds synapses (connections) and axons ( branches). Thinkers brains have known to be packed and condensed compared to people who do not think.

What we lack is focus. Since our brains are constantly working and building terminals, focus is indirectly inhibited by some parts of the brain. What  should take nanoseconds to process, the brain takes seconds . Thus, the “hah?” in your doctor’s conversation is just a delaying tactic for him to reprocess the input.

It is not only doctors who have this dilemma. Busy people and those who are always under stress have this. Especially soldiers who are constantly on the alert for 24 hours will have severe difficulty focusing.

Vitamins and medicines do not help. Yoga and meditation do. If you allow your brains to rest as in sleeping, appreciating the beauty of nature ( not in night clubs, of course) or just stop thinking for a while, the brain will have the time to recuperate.

In the advent of stem cell research, we will understand how the brain works in the future. Today, they can view the activity of the brain by scanning. In a short while, we could identify the thought process itself.

In the meantime, I have to do with social tactics and antics in entertaining my previous patients in order to swim thru forgetfulness.

DANGERS OF DOUBT

THE DANGERS OF DOUBT

            One single iota of doubt destroys all plans and good scenarios one can imagine. In surgery, this destroys all plans a surgeon has envisioned  prior to a contemplated procedure in the operating room.

            When the surgeon suggests  to the patient that surgery is the only alternative to the cure of his/her disease, up front he is trying to convince himself that he can do it and that he can readily cure the patient of his or her illness. This is no easy task since a surgeon’s mind is the most vicious critic of his own  His training, his upbringing, his experience and his current know-how play  a big part in this decision. Once he has crossed the threshold of confidence, he is not out of the woods yet. The patient, his relatives, his neighbors and all the people surrounding him carry a big factor in carrying out the surgeon’s plan.

            More often, those relatives who have not heard the explanation of the surgeon will be the people who will spoil the broth. They will have a better idea than the surgeon….kuno!! The oppositionist would always be that his doctor friend knows about it and that surgery is out of the question. What is more intriguing is that the supposedly expert doctor is not even a specialist of this case. He could be either an Internist commenting about a surgical case, a pediatrician or even a general practitioner.

            Even how small the doubt is if suggested to a patient who (and no other) will go under the knife and no one else could substitute for him,  he will doubt the surgeon, too. No explanation whatsoever could change his mind unless the doubting Thomas himself will correct that mistake to the patient.

            This is ok if the illness or disease can wait and no  virulent  activity is going on inside the patient. What if his case is that of an intestinal obstruction or Acute appendicitis where every minute counts? The delay is detrimental to the patient.

            That is why a second opinion must be official and that the surgeon must see the patient before he can make a diagnosis or recommendation. The problem is that relatives often will only bring the results and not the patient to his clinic. The second opinion surgeon will be forced to make a diagnosis based on paper and not on physical examination. This creates a big difference. There are lots of diseases never confirmed by diagnostic procedures and the surgeon’s hands are the only diagnostic instrument.

affordable medical care

Around the world, people complain of expensive medical care. Nobody can afford good medical care except the rich. I was just wondering why we came to this point when 1,000 years ago the doctor or the medicine man for that matter was not receiving  much except  the dole outs from the tribe or the community. He gathered medical herbs; concocted them and apply to patients without fee. But he never went to school nor use medicines manufactured by others for a fee nor use instruments invented by others. The advancements of medicine has left so many people behind and there is no way we can go back to that situation unless we lose the current way of life by holocaust or global tragedy. Many people have taken medical care into their hands by using herbal medicines or prescription medicines without the advice of a physician. But we can probably redirect  the advancement of medicine to meet the capacity of people to pay.  One way would be easy access to doctors via Internet. I am setting up a website where you can learn and take care of yourself without so much expense. It only takes for you to know what you feel; where in your body do you feel it and what are the associated signs and symptoms. Via, cellphones and Ipads, you can communicate with a doctor direct and converse with him real time. A lot of medical consultations in the clinic are made even without physical examination. Now, I have made doctors more accessible. Wait for the breakthrough in medical care.

Acute appendicitis

I am always asked what causes Acute appendicitis. We don't really know really. It is  the most common surgical illness and until now we still don't know why. And until now, the only method of diagnosis is by the physical examination of a surgeon. No reliable diagnostic method could help in the diagnosis of Acute Appendicitis. This is one illness that you can never do away  the doctor.

claudication

Numbness and tingling sensation of the leg is a sign  of low blood supply often seen in diabetics and smokers. One way of alleviating these symptoms is to immersed the legs inside a pail of warm water for 15minutes 2 times a day.

who i am

Edward R. Cagape  MD

5 Pagsamba Street, PAG-ASA HOMES, BUHANGIN

Davao City, Philippines 8000

(082) 302-1443

SUMMARY STATEMENT

Successfully completed residency training in General Surgery. Passed the board exams. Background includes excellent tenure as resident in General surgery, professorship in a nursing school and medical school, .medical director  of a multinational corporation and a secondary hospital, designed a medical health program for a community and employees of a multinational corporation, president of a diagnostic laboratory and group practice facility, columnist of a locally based mass circulating newspaper, host to a community radio program, vice president and medical consultant to  a local Rotary Club

*Board certified in the Professional Regulatory Commission  of the Philippines

*Passed the written exam of the Philippine College of Surgeons

PROFESSIONAL SERVICE

San Pedro Hospital of Davao, Davao city, Ph                                               1979-1980

                        Internship

International Red Cross, Digos chapter, Digos City, Ph                                  1980

                       Volunteer physician

Digos Provincial Hospital, Digos City, Ph                                                       1980

                        Emergency physician

Dominican Hospital of Digos, Digos City, Ph                                                 1980

                        Emergency physician

Davao Doctors Hospital, Davao city, Ph                                                          1981-1983                            Residency in Gen Surgery                                                              1984-1986

San Juan Barangay Health Center, Agdao, Davao city, Ph                             1982-1983

                        Indigent Community Charity volunteer

Davao Medical School Foundation, Davao city, PH                                       1984-1986

                        Clinical professor

Ministry of health of  Libya, Sabratha, Libya                                                                1983-1984

                         Primary Health Surgeon

Davao Doctors College, Davao City, Ph                                                        1985-1988

King Cooperative Inc, Davao City, Ph                                                                 1986-1990

                        Medical Consultant

Coca-Cola Bottlers Philippines, Davao City, Ph                                                 1986-1992

                        Regional Medical Director

Lingkud Bayan, ABS-CBN, Manila , Ph                                                             1986-1999

                        Medical consultant

Davao Doctors Hosp. Davao city, Ph                                                                1986-present

                        Visiting Surgeon

San Pedro Hospital, Davao city, Ph                                                                  1986-present

                         Visiting Surgeon

Limso Memorial Medical Center, Davao City, Ph                                            1986-present

                          Visiting Surgeon

Brokenshire Memorial Hospital, Davao city, Ph                                               1986-present

                           Visiting Surgeon

Medical Mission Hosp, Davao City, Ph                                                            1986-present

                            Visiting Surgeon

UM Multitest Diagnostic Center, Davao City, Ph                                               1988-1992

                        President

Alterado General Hospital, Davao City, Ph                                                         1995-1997

                        Medical Director

Barangay 22 Health Center, Davao City, Ph                                                       1995-2005

                        Charity Reach-out program

Rotary Club of Davao, Davao City, Ph                                                                2001-2008

                        Medical Consultant

Mindanao Daily Mirror, Davao City, Ph                                                              1996-2006

                        Medical columnist

University of Mindanao Broadcasting Network, Davao City, Ph                        2003-2008

                        Host- Doctor on the Air (Doktor sa Kahanginan)

LICENSURE

Professional Regulation Commission, Manila, Philippines

CERTIFICATION

Philippine College of Surgeons, written exam

PROFESSIONAL  AFFILIATIONS

Philippine Medical Association

Davao Medical Association

Philippine Occupational and Industrial Medicine Association

PUBLICATIONS

Mindanao Daily Mirror

Doctor on the Air radio program

www.diagnoseurillness.com

www.funnymedicalarticles.com

In-House Doctor

The Correspondents – ABS-CBN

LINGKUD BAYAN- ABS-CBN

SKYCABLE – Channel 26-Medical Cable Channel

EDUCATION

University of Santo Tomas, Manila, Ph                                              1978

                                    Doctorate

            Ateneo de Davao University, Davao City, Ph                                      1974

                                   Bachelor of Science in Natural Sciences

         

LANGUAGE

Filipino Tagalog, Bisayan, English

 

txt a doctor

I will be starting a new mode of medical consultation. You can text me anywhere in the world and I will answer you. I will set up the system with our local carriers. In due time you can ask any question pertaining to health. In a few minutes, you will see my biodata. You will know how reliable I am. I have been in practice for 30 years as a surgeon.

steve Job's doctor

If you have been reading FORTUNE mag, you could have read the article on the doctor of Steve Jobs. He was promulgating the use of preventive medicine and very radical treatment of cancer for example. You could also have read the reaction of some doctors pertaining to his regimen. This is a problem plaguing the medical world. We cannot embrace new ideas without first destroying the messenger. A lot of people have been disillusioned because of controversies we find in medical practice.  Now, if you are a history fanatic, you could have known that medical treatment has changed a lot and have turned around in the past century. Whom would you believe now?Follow the wind of change. If you do
not, people will blame you. If you do and it did not work, you can blame yourself. Which is heavier to face, your own conscience or the ridicule of other people?

povidone iodine

For the last 30 years I have seen the bad result of using povidone iodine in dressing wounds. Many form scubs with the wound unhealed underneath and pus forming in it. I have since nonhealing wounds due to constant use of povidone iodine. But if you walk into an emergency room, most of not all hospital personnel would use povidone iodine instead of ordinary soap and water to clean  wound. Many people accuse the medical profession to be stagnant and difficult to adjust to the current trend. I don't know how we could adjust fast.

anticholesterol

If you haven't known it yet, taking anti-cholesterol tablets destroy your liver; no matter what preparation it is. Most doctors would prescribe you one if you have dyslipidemia or abnormal cholesterol findings in your blood chemistry. But I follow a different protocol. Even if you have dyslipidemia, if you don't have hypertension, I will not ask you to take it. The benefit from taking it is less than the risk of developing liver cirrhosis. If you have ischemic heart disease and your cholesterol is more than the normal level, take it.If you have a family history of stroke. heart attacks and vascular abnormalities, take it. If you don't have all these factors, don't.

medical advice

9 out of 10 person you meet when you talk about your own illness will give medical advice and/or medications despite the fact that they never had a proper medical education nor experience as a paramedic.Often these advises  are based on what they heard; hearsay or plain quackery. 2/3 of these advises fail and result to harm or death to the person given the advice. Often times, these causes delay in the intervention of proper treatment like in breast cancer which turns into stage 4 before proper treatment was initiated.  There ought to be a law against this and a penalty should be imposed.

result of self treatment

This was an ordinary sebaceous cyst on the right side of the neck which the patient monkeyed with. She placed all kinds of lenements including toothpaste, mashed garlic, lotions and potions bought from friends and undocumented neighbors( read: non-doctors who play doctor and give prescriptions). It did not appear as a normal sebaceous cyst should and so,  many doctors were misled of the appearance. Many of them thought it was a malignant lymphoma and requested CAT SCAN of the head and neck. Some doctors entertained  GOITER. 7 doctors were consulted before she came to me for advice whether she needs all those lab exams the doctors were requesting including biopsy, AIDS SCREENING, LUPUS SCREENING, MULTIPLE SCLEROSIS and other sophisticated diagnostics. Moral lesson: do not self medicated and never listen to undocumented neighbors.

QUESTIONS

In my 32 years of practicing medicine, I always hear patients asking questions to my secretary instead of directing them to me . Though I am open to discussion and always hear my patients relate their stories, the hours they stay in front of me is not adequate. They have more questions when they go out of the clinic. They often lose words when they are in front of me

numbed forearm

When you start having numbness of your arm, especially the arm you are often using to work on the computer, you are  having nerve palsy due to your static  position ( same posture for more than 4 hours on the monitor). There is no relief with any medication. You have to rest your arm for 24 hours and massage the muscles of the back and arm. Then start taking analgesics like Mefenamic. When you back to work, rest every 45 minutes to allow the muscles of your extremities to relax.

To viagra or not

Don't count on it. It depends on how desperate you are to have sex. You don't even need it if your libido is high. It may cause a prolonged hardness but it does not increase the number of ejaculations. Most of the time, the action of the medicine is so delayed that you thought it did great. But it was not. Your psychological desire to have sex did a good job than the Viagra.

THE ABDOMEN

We surgeons call the abdomen the temple of surprises. No matter how good we are in physical examination and diagnosis. No matter what kind of diagnostic exam would we use to confirm our diagnosis. We are surprised by the outcome in some 20\% of cases. An acute appendicitis could turn out to be a twisted ovarian cyst or worst  ectopic pregnancy.  The most difficult surprise would be a case when we are not prepared to do like when a patient was diagnosed to have a gastric tumor and will turn out  to be a pancreatic head tumor in the 4th stage. Most often these cases end up as an open-close surgery.

circumcision again

I often tease my young patients who would reluctantly come for circumcision. Oftentimes, it is the desire of the father or mother or grandparents that these youngsters undergo surgery and not of their own wish. Thus, when they come inside the clinic, in a loud voice I would ask them whether they came because they really like to have a circumcision or probably was forced to come by these relatives. When they do not respond immediately, I would add that if  it was not their wish, let the father undergo circumcision instead of them. This usually gains a smile and confidence from them.