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. 

TINUY-AN FALLS

What does this picture got to do with medicine and health? I have been in practice for 31 years and because of my hectic schedule I have not visited any of the wonderful tourists sites of my country. When I went to this falls, great pride surged into my being and a lot of good endorphines flooded by senses. I have been in financial crises lately and this place gave me a boost to face odds which to me were cliff hangers. If you feel down and depressed, go for a vacation  just near your place for you to free yourself from psychological handcuffs

17 days of a diabetic foot gangrene

17 days after

10 days

1st day

You can see on the left upper corner of the picture of the diabetic foot gangrene 17 days after I first saw it. Compare it to the first day, you can see the viability of the foot. If I could have been in a hurry to cut it, this patient could have been an amputee all his life. The camera could not show how good the skin has become. This is just to show that there should be patience in the part of the surgeon. But the protocol followed by most surgeons could have amputated this foot. 

RIGHTS OF THE PATIENT

More and more companies control the lives of their employees. When they register their employees to an HMO or to a retainer physician, this practically ties the employees to a particular doctor not of the employees choice. This disrupts the medical history of the employee to that particular doctor and more often than not, dissatisfaction creeps in between the patient and the new doctor.  The new doctor examines the employee routinely ( most often haphazardly) because he receives a fixed amount for every patient unlike the enployee's doctor of choice who had created a rapur in the years that they had seen each other. And this is the main reason why patients sue their doctor in the event of un-acceptable result of medical care. If we doctors want to decrease the incidence of malpractice suits, we should insist to the patient to develop a personal touch with his doctor before he goes into a more complicated medical care procedure. 

INSOMNIA

You can always take some drugs to go to sleep. But the natural-normal way to go back to sleep is to make your brain rest. When you hit the sack and you cannot bring yourself to sleep because of so many things entering your mind, get up, walk or do some readings. Or,  think about what is bothering you until the time you are nodding. This comes when you have already made up your mind what to do with the problem or you have come up with a solution. Drinking milk or sipping tea is a ritual that could help but this is due to the calming effect of the act of drinking just like smoking. Most people stay in bed despite the fact that they cannot sleep. This causes more problems to your brain. You toss and turn which activates a lot of muscles thereby increasing a vicious cycle of muscle contraction and thinking. Get back to bed and close your eyes without forcing yourself.. Think of empty space like a beach or a desert and nothing to see except the sand or the sea or the space where nothing is moving nor anything to attract your attention. Some people think of clouds. But this usually triggers a lot of memories just like the beach or the desert for some people. If all these scenarios cause you to think more, think of other things that would bore you. 

depression

Though we seldom see a lot of patients complaining of depression, the incidence of depression is rising due to the economic situation and personal reasons. And the treatment of depression is often inadequate to address the problem. Once the patient wakes up from the anti-depressant drugs prescribed, he/she often dives back to the depressing state if his/her problem had not been solved. More often than not, his problematic situation will be solved on its own even without the patient finding the solution. Suddenly, the future looks bright despite the fact that the problem was not solved. The main ingredient in the sudden change of his psychological situation is ACCEPTANCE of whatever will happen next; no worries, no more anxieties  and plain acceptance of whatever the future holds. And this acceptance can always be initiated by going out of the house and finding any distraction from the present situation. The new location like a beach or a mountain perverts your senses and your brain to go back to the problem which you think you can not solve on your own. You have done whatever you can and the problem does not go away. So, by distracting your brain from depression, you go out and find happiness in everything different that you see no matter how trivial it is.

to shave the armpit or not to shave

Because of social norm, women today shave their armpits to remove unsightly hair. But because of abrasion  or small lacerations caused by the blade,this usually caused furuncles or small abscess in the area. This in turn causes the blockade of the normal growth of the hair follicle producing cyst or small lumps in the armpit necessitating surgery.

The appearance of liquid  hair removers has diminished the incidence of this tumor formations. But the side effects of these liniments like blackening of the armpit have prevented widespread use. 

herpes zoster

Painful vesicles on the arms are not very common for herpes zoster to form. More often, we see them on
the chest  in the elderly. But nowadays, we see them all over the body; lips, forehead, legs, flanks and back. We have to rewrite medical textbooks for these changes.

diabetic foot gangrene 10days

The patient refused to have the amputation. He had episodes of depression and for the last three days  could not sleep. And look what happened!! There was improvement in the blood supply in the toes. The dark point on the toes disappeared. There was marked improvement in the blood supply of the foot. Moral lesson: longer patience for the doctor; and perseverance and a lot of luck for the patient.

result of self medication

He may look normal for an Asian child. but if you look closely, his eyelids are puffy and swollen. This is the result of self-medication of Co-trimoxasol; an antibiotic very commonly given to Filipino children when they have cough even without prescription. There was an allergic reaction to the antibiotic. Good that the allergy did not affect the kidneys as was shown by ultrasound and creatinine determination.

need of medication

30% of patients do not need medication when they consult a physician. Most of them have self-limiting diseases usually viral and there is no treatment for viral infection  except for a few. If you have fever for example, check if you have colds. Definitely you don't need antibiotics if you have colds. You only need antipyretics for fever and pain relievers and a lot of rest.

amputation refusal

Most patients if they can only do away with surgery, they will refuse it. My  patient who had diabetic foot gangrene refused to have the surgery. Instead, he went home and nurse his own wound. I don't know when I can do the amputation.
The preservation of one's limb is always the primary goal of a patient no matter how critical the amputation is. Most would not accept the explanation that if we cut his limb he will survive.. Many patients would rather preserve their gangrenous foot than to lose them no matter what. But all of them would beg to have the surgery when it cannot be done anymore because he/she could die during the procedure.

diabetic gangrene 72 hrs later

You can see in the pictures how the gangrene has worsened. But the fact is, the patient still insist to have his foot and would not like any kind of surgery. There is a slight increase in the vascularity of the surrounding tissues by the presence of bleeding during dressing but the yellowish portion is not improving. The dark portion of the  plantar area is slightly lighter than before signifying improvement of blood supply. I talked to the patient  this morning and tried to convince him to have a below knee amputation but he would rather die.

diabetic foot

All patients with diabetic gangrene of the foot would always choose to have their foot and never agree to an amputation. They usually would only give their consent on the last minute. In some cases, it is the doctor who will make the decision by force to save the life of the patient. Because of this, doctors would tend to be radical and amputate further up the limb instead of conserving the remaining foot. For a small lesion, the whole lower extremity is not spared. For the last 31 years, I have geared towards conservation. If I can spare the foot, I will  do debridement conservatively and allow the foot to grow more tissues instead of amputating. And I had very successful rate in these patients to preserve their foot. Though it took months for them to have a normal foot, at least, they had their foot and walked normally unlike amputees.

to amputate or not to amputate

Enclosed is a diabetic foot of a 52yr old male, diabetic.This is the appearance of the foot 1wk after onset of symptoms. He had been diabetic for the last 5 years and drug intake was irregular. Pulses on the foot are normal. Do we amputate?

dropping dead

We seldom see people dropping dead on the streets nowadays. But it was very common in the 50's because of the absence and/or the existence of preventive medicine like annual physical examination and blood chemistry.  Today, when people feel something abnormal, they go to the doctor. In those days, it is something big to go to a doctor and they usually go to one when they really feel bad. Thus, we seldom see people unable to reach the threshold of the hospital.
Now, unlike medicine, computers just blink and drop dead without you doing anything wrong. My computer did yesterday. That is why you didn't  see any fresh blog yesterday. If only somebody would install preventive maintenance on our computers long before they just drop dead like the thing will just repair itself in the evening while the unit is not being used.

25 yrs post breast cancer

 A patient of mine recently visited my clinic whom I diagnosed to have infiltrating ductal carcinoma ( breast cancer) stage 1 in 1987; 25 years after I removed her right breast. Most of you would surely say that most breast cancer only survive for 5-10 years. I do have a lot of patients who did survived more than 15 years after surgery after chemotherapy. If you keep tab of the multimedia releases, what you often hear on breast cancer is grim. The long survival rate of my patients is due to early detection by physical examination not by ultrasound or mammogram. Some women do away with physical examination by an expert surgeon  and go straight for these diagnostics. Nothing could substitute for a good physical examination

prostate cancer

We should be thankful for people who do statistics and trials. If not for them, we would be following the same protocol of medical management. Look at PROSTATIC SERUM ASSAY. Study was done on the significance of this test for prostate cancer. The study showed that it only heightens the panic of the patient if it is positive but does not extend his life; and to the doctor to do radical surgical management like prostatectomy which produces complications like impotence without so much benefit to the patient's life and well-being.  Using PSA for prostatic cancer screening does not even give any significance in the management of  this disease. And yet, we never hear of statisticians being given awards or a Nobel price.

engrown toenail

You will be surprised how many I operate every week because of engrown toe nail. And the reason for this illness is because of frequent pedicure. Let the toenails grow more than the toe for a awhile. Don't cut the corners. This will allow the toenails to insert into the side tissues

hemorrhoids

I operated on a very large external hemorrhoids yesterday. I was wondering why  people wait this long to have an operation such as this. The operation is simple for me but the problem is complications such as wet anus or incontinence is very common in large bulging hemorrhoids. Many people would postpone or rather would not have the operation for fear of these complications. But they do not know that a simple technique for simple hemorrhoids has absolutely no complications ( diamond technique as compared to white head procedure). Many people end up with fistula in anu which is a more dreadful complication because this creates a canal way up the anus. I forgot to take pictures of my operation yesterday but you could not imagine how big it was.

legacy

While I was reading TIME's  100 most influential people, I was made to think of my career for the last 30 years as a surgeon. The perineal problem that I often encountered in my practice was the lack of money to buy medicine. The doctor was available and consultation can be had in most government hospitals. But the biggest problem that patients encounter was how to buy the medicines prescribed. I got to thinking that why is this. A lot of movements and foundations face problems like AIDS, MALARIA, TUBERCOLOSIS but none is addressing the most common problem of patients: the treatment of very common illnesses such as UPPER RESPIRATORY TRACT INFECTION AND URINARY TRACT INFECTION. These diseases need antibiotics and no charity foundation or cause is addressing this problem. Why not form a group that would address this common problem and help a lot of people more than AIDS, MALARIA, TB, POLIO combine.

Belief in doctors is dwindling

I was just wondering why so many people would rather believe in what they hear from their neighbors more than doctors would say. They would believe everything they read and see on tv or internet and doubt the doctors whom they consult. There is an increasing mistrust with the medical world. Back in the 19th century, what the doctors say would be taken hook, line and sinker. Today, a second opinion is a must or even a third would be preferred by a patient rather than plunging direct to whatever medication is suggested by the physician. Most of the patients I see either had began self medicating before coming to the clinic or had seen several physicians and did not believe what they said.

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.