What to eat and what not to eat - GALL BLADDER STONE

GALL BLADDER STONE

If you don’t have the desire to have surgery for now and you would not like to have the symptoms of bloatedness, epigastric pains, back pains and the feeling of indigestion, don’t eat fatty foods, dairy products, any food cooked with cooking oil, very high carbohydrate concentrated delicacies (cakes, pastries). That is almost everything in Asian diet and dinner for Caucasians. Well, if you don’t like to have those symptoms above. If you cannot live without indulging in these food products, have the surgery. It is a matter of this or that. This is because the gall bladder stone is forced to enter into a smaller tube whenever you eat these food products. The smaller the stone, the acute the pain. If you are forced to eat them as in parties or socials, you can find relief of the symptoms by drinking citric acid containing juice: pineapple, apple juice, lemon juice ( lemonsito) in high concentration; meaning, no water mixed with them. Of course, you have to make way for the bad air coming out. You will pass flatus in a few seconds. If there is no relief after drinking the above concoction, do it again until you pass flatus. You will have watery stools (poops) after that. No amount of anti-spasmodics could surpass the effectivity of this concoction. I have prescribed this to so many patients who fear gall bladder surgery in the past 31 years including myself.  

ANESTHESIA MYTH

I always hear patients complain that they were operated without anesthesia for furuncles, abscesses and pus forming wounds. The common concept of surgeons  is that pus or the presence of infection-abscess will prevent anesthesia to diminish pain. But I had a different experience. All of my patients had local anesthesia infiltrated around the pus formation or infected wound and I was able to debride or do incision and drainage on them without pain. Of course, The surgeon should never inject the anesthesia on the abscess itself since the milieu in this area is acidic and local anesthesia like lidocaine would never do its job. Inject it around the affected area where the boundary of normal skin and cellulitis is. The patient has borne so much pain already having those boils. A little less of it is heaven for them.

food poisoning

130 students were admitted in the hospital yesterday because of food poisoning. Vomiting and loose bowel movement  were the main complaints of the students after consuming several kinds of food including coco juice, adobong chicken and chicken salad.
Nobody could prevent cases like this. The smell of the food could not give away the presence of bacteria if it is consumed early.
Though dehydration is the main result of this illness, this could trigger graver problems if not admitted to the hospital.

HEALTHCARE

Which country really provides the best health care?
I have a lot of patient expats from all over the world. They have one complain in common: their healthcare sucks! Whether it be socialize medical care, Obamacare, HMOCARE, or no care at all, no one seems to be satisfied with the delivery of healthcare in their respective countries.
What is the best medical care that I could think of? Social medicine provides cradle to grave support but because of the bureaucracy, a lot of their population complain of seeing their doctors 30-60days after their symptoms start.. Well, they say that if it is an emergency they could go straight to the emergency room. Private medical care is best if you have the money. Most social medicines are being abused  in countries ruled by totalitarian/dictatorship governments. I have seen how medicines are thrown into the garbage cans by patients dissatisfied with the service.
We have seen how taxes rise when healthcare is increased in some countries. If only we can balance healthcare with taxes, we can have an ideal healthcare.  If we can have the technology wherein taxation is individualized and pegged on the usage of the healthcare service, this would probably deliver an ideal budget for healthcare.

breast masses

It is fear of cancer that drives women to seek medical consultation. The information on breast cancer has generated a lot of awareness to the point of producing fear in women. To think that only 5% of breast masses are cancer and only in the ages of 30 years and above that we find breast cancer. Thus, I often face a very anxious girl in her twenty's  with a breast mass and it takes a lot of coaxing and talking to tell her that there is nothing to fear.
But before she had decided to seek consultation she injured nights of useless anxiety which to my mind is so depressing.
This is a set back to medical education extended  to layman. On one hand, it is good people are made aware of cancer. But on the other hand, we cannot impart the whole gamut of medical information unless you go to medical school. Little knowledge is a dangerous thing.

WHAT TO EAT AND WHAT NOT TO EAT - DIABETES

DIABETES MELLITUS
You are in for a surprise. You have a very high blood sugar and yet I tell you that your body lack sugar. It is because the sugar that your body is producing and the sugar that you are eating stays in the blood stream and cannot enter the cells and tissues of your body which need it most. And the reason for this is the lack of insulin which is the hormone responsible for carrying blood sugar inside the cell.
Your doctor would insist that you have to bring down your sugar intake in the forms of soft drinks, pastries and plain sugar in the coffee. The reason for this is because your organs are being destroyed by the excess sugar and yet your cells are still hungry for sugar. The brain for instance cannot use any other source of energy but the sugar you are eating and the stored sugar you have in your body. The moment your insulin is not adequate to bring in to the cells the sugar they need, you start to get hungry and the body manufactures more sugar from your tissues ( body fats).
If you are still hungry and you start to diet, this will trigger the body to produce more sugar from your own tissues. You are eating yourself.
Even if you are diabetic, you can eat anything; in fact everything on the table can be eaten except the spoon and fork, of course. But in moderate amount. Even sweets, pastries, cakes, ice cream and whatever food rich in sugar can be eaten but in moderation.
Nobody ever told you to starve yourself. But because most doctors do not explain, most diabetics overdo themselves.
How do you know what you have eaten is enough for a diabetic? The size is usually half of what the non-diabetics are eating. One half of a  slice of cake, for instance,  is good enough. It will not raise your blood sugar to very high levels if you test yourself the next day. What is important is that you did not miss your medications. Make sure you have achieved the best level of blood sugar with the medications by having a regular check of your HBA1C. But never indulge on anything sweet. Always bear in mind that you are just preventing your body from eating itself.

WHAT TO EAT AND WHAT NOT TO EAT DURING ILLNESS - HYPERTENSION

WHAT TO EAT AND WHAT NOT TO EAT
DURING ILLNESS
I
IHYPERTENSION
You have heard from friends and even doctors tell you not to eat fat if you have hypertension. But you have to realize that the fatty food you are eating right now is not the cause of your hypertension per se. It was the fatty food you ate when you were 25 years old  and all the cholesterol laden meals you ate up to this time.  The hypertension is caused by the cholesterol(fatty food) which have deposited in your arteries and not the cholesterol floating in your blood stream. These floating cholesterol may be contributory to more hypertension in the next 5 years of your life.  No medicine can remove the plaques that are deposited in your arteries and the rigidity of these tubes due to aging.  The statins you are taking (simvastatin etc) are preventive drugs that would block further increase of cholesterol plaques. If you have been taking these stains when you were still 25 years old, you won’t have cholesterol plaques today causing hypertension. So, go ahead eat a few bits of fatty foods. Remember, a lot of enzymes and hormones are made from fatty substances you eat. Decrease the supply of these important factor of your diet, the lesser will your body function. Even the digestive system and the endocrine system of your body responsible for absorbing protein and the production of sexual hormones are dependent on fatty foods you take.
Daily intake of Fatty food the size of a match box is enough to supply the necessary fat nutrients of the body.
But the food you must avoid are those with so much salt in them. Salt or Sodium increases the volume of blood because of its water retaining  capacity thereby increasing the blood  pressure. Salt and fatty foods are a deadly combination.  Join a water retainer and cholesterol producer will produce a tsunami effect in your blood pressure.
OKRA has a diuretic effect. It causes release of water thru urine formation. However, it increases the amount of Calcium and Potassium in the blood. If you are taking calcium blocker anti-hypertensives, this will diminish the efficacy of the drug.
Some doctors think that diluting the viscosity of the blood may help in lowering blood pressure. Thus, they advise patients to eat a lot of lycopenes. Tomato is one.  However, the benefit of eating a lot of tomatoes have to be further studied.
Here in the Philippines, a  fad has risen a year ago in the consumption of ginger to lower blood pressure. Studies have shown that it only thins the blood and lower cholesterol. However, it is not a good anti-hypertensive  per se.
Garlic has long been known to lower high blood pressure by lowering cholesterol. But a massive study done in Europe showed that it does not have any effect in lowering it. In fact, it interferes with anti-hypertensive medicines such as calcium channel blockers ( nefidipine).
Lemon grass ( tanglad) despite its being commonly mentioned as good for antihyperntension never showed any properties of lowering blood pressure.
Some people notice the rise of their blood pressure when eating sea foods, goats and lambs, spicy foods and protein rich foods such as peanuts and butter. If the rise of blood pressure occurs a few seconds after ingestion, this is psychological and should never be pinpointed as the culprit because this reduces the choice of food a hypertensive could have in the long run. Though hypertensive, these patients should have a well-balanced diet.
Some people with hypertension start to refrain from eating eggs (some eat the white portion only) in the belief that eggs causes increase in cholesterol. It does in large amounts. But a single egg supplies most nutrients the human body needs. It is the most complete food there ever is. A single egg does not increase the risk of hypertension but it provides 90% of the vitamins and minerals and nutrients we need.
Source:www.whfoods.org     Wikipedia

post operative pain

With the advancement of medical science goes along with it the lowering threshold of  pain. We have conquered pain  and have diminished it to the point of  painless diseases. But the drawback is more and more patients need higher and higher dosage of these medications. We cannot tolerate even a tinge of pain.
We used to administer ordinary pain relievers for simple surgeries like herniorrhapy. But nowadays, some patients need opiates to be relieved of post operative pains.
There will come a time when we will be needing injectables for a simple migraine headaches. 

BORN TO BE A DOCTOR

I really didn't plan to be a doctor. In fact, I went to the seminary to become a priest. But someone or something really lead me to become one. I breezed thru medical school and residency training and found myself caring for people whom I did not know from Adam. I never thought of the money and stability and prestige. In fact I usually find myself pitying patients in the other beds not under my care. I have so much compassion but not so much patients. Anyway, I find myself enjoying  patients who smile and thank me after a major operation. Every patient who comes under my care is very fulfilling for me. If  I could have been a priest, I could have been a Bishop or probably a Pope. Do you think so?

SURGEON'S DECISION MAKING

All these years that I have been a surgeon, the time that I most dread is when I open a patient after so much deliberation, diagnostics and sleepless nights.We really do not like to be surprised by a different finding intra-operatively. The reason why patients undergo so much work-up before surgery is because  we are trying to answer all the "what ifs" under heaven.  You cannot imagine how much anxiety a surgeon feels when intraoperatively he finds a different ball game. That is why, an experienced surgeon is the most sought after operator there is. We do not have the luxury to open books or ask our colleagues when we are in the middle of a surgery. The buck stops in our hands.

FORGOT TO BREATHE

Funny, but a lot of us forget to breathe properly including me. Headaches, chest pains, palpitations, anxiety and even depression may be caused by improper breathing. Our breathing is composed of two phases: a voluntary one wherein we decide consciously to breathe and the involuntary component which is an automatic inhale-exhale cycle of which we are not aware of. The latter is controlled by the amount of carbon dioxide in our blood. But if we have the habit of short breathing, this becomes the benchmark of our respiratory center to stimulate the lungs to expand as much. Though many people do not realize it and even the doctors they consult , this is a simple thing to cure. I have seen a lot of patients who complain of these symptoms and have consulted a lot of doctors after which they underwent diagnostic exams to find nothing wrong with them.
 If you have the above symptoms, start breathing deep for a few cycles  but do not overdo it. It may cause dizziness and headache and even lost of consciousness too. Do this frequently in a day's time and reset your respiratory center baseline. Doing so, the respiratory center will adjust to a normal ventilatory cycle which do not cause headaches, chest pains, palpitations, anxiety and depression caused by low oxygen in the blood.
You will also feel good,too, and beautiful pinkish face as a bonus.

OPEN MINDED DOCTOR

We doctors believe in ourselves and believed in what we have learned. Most of the time we need this in order to have the courage and the convincing power to ask a patient to go into surgery. Because of this, it is very difficult for us to accept a new dimension of treatment if it was never taught in our medical curricula. Peptic ulcer for instance. It was only a few years ago that the dictum of ulcer pathology  was changed to a infectious one. It is caused by a bacteria: H.PYLORI. We never learned that in medical school. It took sometime for us to adopt to the new thinking.
I never heard of CHIROPRACTIC MEDICINE in my medical school days. Either my professors never heard of it or they just kept mum about it. But what a surprise. When I was able to hear and listen about Chiropractic medicine, my mind was opened to a new dimension of healthcare. I used to refer my spinal stenotic patients to Orthopedics or neurosurgery for treatment. Disc pathology I thought was included in the realm of  surgical procedures. Then, here comes CHIROPRACTIC MEDICINE.
I had a lot of patients who underwent a lot of orthopedic referrals without any relief. Then, with my new knowledge of CHIROPRACTIC medicine, I was able to find relief for them. Foremost in my mind is to find them relief from pain and analgesics and anti-inflammatories never provided them.
If only we could be opened to other modalities like holistic medicine of India; herbal medicine of China or even the voodoo practices of  Dominican Republic just for the sake of the patient.

SLIMMING

If you have noticed, slimming salons have sprang up in almost every corner of the city together with spas and massage clinics. But magazines and newspapers scream of  overweight pandemic all over the world. I also kept noticing a lot of people having beer bellies even in poor countries. Now, what is this? We can always blame junk food and buffets and a lot of unhealthy cuisine. But what do you see on cable tv? FOOD. Where are we going in this generation? ON one hand, high cholesterol and on the other hand, sumptuous food. If you keep on listening and looking at these situation, we all will get crazy. LIVE AND let live.

KIDNEY STONE

This is a kidney stone passed by a male patient by urinating. Imagine how painful it was. It is as big as a bean and you cannot imagine how difficult it was to pass out thru the urethra. This gives you an idea that the body could produce amazing things like blue colored or white colored poops.

alkaline water

In college, we doctors have 20 units of biochemistry dealing on the real ionic situation of the human body chemistry. Then, in medical school, we had 10 months of biochemistry and 10 months of physiology. In all the subjects that we dealt with up to the time that we graduate as an MD, biological chemistry was always on the subject matter. During my surgical residency, the first year training was on the physiology and nutrition of the patient.
Now, here comes this new vogue of alkaline water good for the body and prevention of cancer. Hah!! If you monkey with the pH of the human body, it responds with great consequence: metabolic alkalosis very dangerous to one's health. Here is how it is:
The body always maintains its pH: 7.4; no matter what you do if the body is healthy, it will find a way to go back to that physiologic pH because it is the normal level of the human body to function. If you drink alkaline water, this disrupts so many organs in their normal function just to cope with  presence of this unhealthy level of the pH; the lungs will increase respiration, the kidneys work hard to expel more bicarbonates and minerals; the intestines would not absorb a lot of nutrients to prevent ALKALOSIS.Why? At this level of body pH, the brain cannot work well; the nerves cannot transmit a lot of signals; the heart cannot pump well and every thing else in the body do not work properly.
Why do people who take this alkaline water feel good? For a time, it is. But in the long run, they will have easy fatigability because their organs are working double time.
I am really amazed by people who claims things they don't really know. More amazing, there are a lot of people who are gullible enough to believe them. You can always ask the people who know the real score before you jump into a vogue.

complication of obesity

Seldom do we see this complication, but I operated on a 53 yr old female who had a VENTRAL HERNIA. This is hernia or outbulging of the intestine into the wall of the abdomen. Her case  was caused by the thinning of her abdominal wall due to the increase of intestinal fats enlarging her abdomen to extraordinary proportion. But there is weak point in the abdomen which is usually the point of the herniation and it is located at the level of the umbilicus.
On operation, there was a matted portion of the omentum protruding thru a hole the size of a golf-ball. I had to trim the  omentum to allow the rest of the intestine to go back inside the abdomen.

DIABETIC FOOT GANGRENE 24DAYS

Judge for yourself whether it was right we allowed the patient to have his foot. This is his 24th day with daily dressing of silver sulfadiazine impregnated in the gauze bandage, vascular dilators and  oral antibiotics. The foot has regained its pinkish color.  where it was whitish 24 days ago. Demarcations of good flesh are coming out on the edges of this pinkish area. Where there was soft subcutaneous tissue palpable, it was replaced with enduration and hardening of the area. The foot does not smell anymore. The toes are going back to their normal color except for the tips. I give him another 30 days to decide whether to amputate or not. His creatinine is going down from a high 400 to the present 370.

MOVIE REALITIES

I was watching an episode of "I COULDN'T  HAVE BEEN ALIVE"  in Discovery channel where the man went trekking and broke his legs. I was wondering why he never thought of splinting his broken legs when there were a lot of sticks around him. For people who do mountain climbing and leisure walking in the mountains, they should have a training in survival and how to care of themselves in an emergency. In this case, he should have brought duck tape with him for emergency. And then, splint his broken legs in such a way that he will not be placing any weight on them. by extending the splints way down about4 inches below his feet, he could walk with the broken legs hanging and the splints bearing the weight

abdominal pain

Distinguishing between an abdominal pain secondary to a surgical illness to a medical one is very important when you think of self medicating. I have seen a lot of patients whose symptoms were mask by the medications they were taking trying to save on hospitalization. We ended up with a complicated surgery.
The dictum in knowing whether you need to see a doctor or not for an abdominal pain is the persistence of pain. If after self medicating and the pain recurs or persist within 24 hrs, you 've got to see a doctor.

SUPERMAN 15

Well, the movie is not even conceptualized by DC comics ( or is it Marvel) yet. But what I am talking about is almost similar to Superman. He loses power whenever he stays in the dark for a long period of time and not just kryptonite.
We humans have the same tendency. We go into depression.  Many people  have not realized it but staying outside of the sun's rays are detrimental to your health.  It only takes 15 minutes under the sun for a cure of depression.  Patients most often depend on drugs to get them out of depression by sleeping on it. What they could have done was to get out of their houses and stay out under the sun for 15 minutes.
I do not have any explanation but I have subjected a lot of patients with this ordinary treatment who underwent major surgery for the last 31 years. It was really surprising. Most if not all patients who went thru surgery go into depression especially those who had cancer treatment. After so much coaxing, I had convinced them to go out into the sun and leave their antidepressants. Most of them have not taken any antidepressants ever since. 

weekends

How do you spend your weekends fruitfully?  Everybody knows it is the time to recharge and relax. But what really is the best thing to do during weekends. Most people would think of exercise,  go for a picnic or get some tan.  But there is something left out  in this process. Most of these activities are physical  but the brain is the most taxed organ in the body during working days. Give it a rest, too.
One way of providing rest to your brain is exploring nature or involving in extracurricular activities which are not related to whatever you are working. Acquiring new knowledge about nature and the things around you not necessarily going out of the house. There are a lot of things we do not know. By giving your brain activities which have never been involved with, you are giving it respite from a cyclic neurological response which consumes a lot of energy at the same time diminishing the nerve's capacity to respond to stimuli. The nerve pathway involved in routine work practically numbs its normal response.  This the reason why you become bored and your work becomes haphazardly done.  By involving in a different knowledge quest, you are opening a lot of new  nerve pathways refreshing the production of new nerve trunks thereby renovating the makeup of your brain.

column writing

I wrote a column in our local newspaper for 10 years about medicine. Though I seldom got any response from my readers, It was very satisfying to hear from them that they were reading my articles. But what is more fulfilling was the fact that they learned a lot from them.  Tome, what is lasting is the pinnacle of my happiness in practicing medicine

COMA

When do you say that you are giving up on your love one who is in coma? In my 31 yrs of experience, it is not the people around the patient who decides.  It is the pocket or the finance. When the relatives around the comatose patient even how close they are starts to feel the pinch of money, that is when they decide whether to go on caring for the comatose patient or remove the life supports. When the people around the patient are greedy and would rather take care of their own lives than to spend for  their love ones, they will go to court just to remove the life support. And most of the time, these people would argue under the pretext of giving rest to the patient.
Caring for a comatose patient is psychologically draining no matter how strong the love is. And the people who care for them lose their own psychological identity and  even would not care for their own health. So, when you do say enough is enough? You don't have to. The money will make the eventual decision for you.

SYMPTOMS OF HYPERTENSION

A lot of people ask why they don't feel anything when their blood pressure is on the rise. The word is INSIDIOUS,. Blood pressure does not rise overnight. It rises slowly as if to accommodate  the rigidity of the aging arteries.  Headaches and dizziness come later . Thus,  when you wait for the symptoms to come in before you will have your blood pressure taken, you are too late.
Other people stop their medications when symptoms disappear.Wrong move. Antihypertensive medications only protect the patient from eventual stroke because they lower down pressure  by blocking  ( in the case of  beta blockers) or prevent ( in the case of  calcium inhibitors)  further rigidity of the arteries. This is like a car on a hill being pushed upwards. The moment the the car is let go, it goes downhill.
Why do exercise bring down blood pressure? During the physical activity, the heart pumps more blood and increase pressure into the blood stream. These two factors dislodge cholesterol plaques in the arteries responsible for  the rigidity and blockade of the blood vessel. More blood vessels are reopen, less pressure. Nothing can substitute  exercise in the treatment of hypertension.

cholesterol

The medicine you are taking for anticholesterol is only for the cholesterol floating in your blood and not on the cholesterol plaques which is the cause of narrowing of the arteries. Now, we are giving medicines for anti-cholesterol in the hope that less plaques would form. In the meantime, the preexisting plaques remain. In some hypertensive patients, the cause is the presence of these cholesterol plaques in the arteries. Taking the anti-cholesterol reduces the likelihood of stroke and/or the persistence of very high blood pressure. But not all patients benefit from this therapy. If all patients are forced to take the present protocol of hypertension management taking the anti-cholesterol,  cases of liver cirrhosis will rise. Where are you now in your hypertensive therapy? Talk to your doctor if he is aware of this. I usually discontinue anticholesterol medicines when my patients do not lower their blood pressure after 6 months of taking this anticholesterol.

contradicting therapy

Medicine is really an art. We know that a diabetic has to lower down his sugar. But if you analyze what really is happening inside the body of the patient, it is not the sugar who is the culprit. Though it produces a lot of bad effects in other organs including the kidney, it is not the reason why a person has diabetes. It is the lack of the delivery boy who carries the sugar inside the cells of the body: the INSULIN. If insulin is not adequate enough to deliver all the sugar inside the cells, high blood sugar results. Now, if a patient is weakening and has lost energy to perform basic daily routine, he is lacking sugar inside the cell but so abundant inside his blood stream. His cells are calling for help from the organ makers of sugar: the LIVER. From the calls of the cells for help, the liver responses by producing more sugar from the fatty deposits of the body and even from the muscles. But there will come a time when these sources of sugar produce byproducts harmful to the body. What does the liver do? It stops producing sugar. The patient becomes weak and unable to do routine chores. If the patient refuses insulin, he is given oral hyopoglycemics which bring down sugar by throwing them out of the body via the kidneys or preventing the absorption of sugar from the intestines. Where is the cell at this point? It is still hungry for sugar all the more because the blood sugar is depleted by the presence of hypoglycemics.

Nothing can substitute insulin. What do we do with a diabetic patient with a normal current determination of blood sugar who is becoming weak and lethargic? Let him eat sugar.

chiropractor

Chiropractic medicine is new in my country; about 10-12 yrs. IN fact I introduced the first practicing chiropractor to my city in my local newspaper column. This added a new dimension in the care of our patients. I used to insists surgery for slipped disc but because I found the chiropractic therapy better than surgery as I found out from my patients who underwent chiropractic manipulation, I have been drawn to their care in some other diseases that  the western medicine has not provided.