Beginning Again

After 8 years of hibernation, I decided to blog again. There are so many things I want to talk about but at the moment, I begin again.

I will still cotinue writing about the daily anecdotes of each day as a doctor, a mother, a wife and a daughter.

Life has completely changed since my last entry. Just the same I would like to share stories.

And yes, I am  beginning again.

A MAN WILL REAP WHAT HE SOWS...

A month ago, I had an 81 yr old female patient, retired teacher who suffered from stroke. She is quite on the heavy side and couldn't talk coherently because of the cerebrovascular accident. She was subsequently admitted and was referred to a neurologist. During my first rounds, I started counseling the family already regarding long term care for their mom. When I had the chance to talk to her daughter, I told her that now is the best time to show her mom how much she had loved them and how she took care of them when they were young. To my surprise, the daughter answered ;" Im sorry Dra, hindi nya ako maaasahan diyan! (she cannot rely on me to do that) , lumaki ako sa katulong! (I grew up with my nanny)"....

Sometimes, we thought we did a great job raising our kids. We worked hard to give them the best education and the best life but we forget that a simple hug and daily time devoted for them is enough to make them remember how we love them so dearly.

Sowing good things is never too late... even in our twilight years, to age gracefully, one must learn to sow good things-- for his physical health, for the community and neighbors where one lives, and for one's mental health. The truth is... we will only reap what we sow...

My Geria Babies

There was a time when the secretary in one of my clinics called and said "Doc, your Geria babies are here already!". True enough, I had 5 patients waiting in the clinic at the age range of 79 to 90 accompanied by their adult children. This is in contrast to the patients of the Pediatrician with me in the clinic with patients who are babies accompanied by their mothers.

Many times, elderly, particularly the old-old, are in my clinic because their children could no longer understand their behaviour. They easily forget what the doctor just told them and they easily get irritated when they forget things. Their children get irritated too because of fatigue both in work and in taking care of them. One daughter, after the consult, stayed and asked if she could talk to me for a while. While the father left, she started to become teary- eyed. She said she doesn't know what to do. She gets tired reminding her father to take his medications. She gets tired checking on the food he eats. She gets tired being reprimanded by him when he is irritated. She gets tired seeing him sleep in the morning because she knows he will be awake at night and they sleep in one room together. While narrating her misery, I listened and looked at her straight in the eyes smiling. She paused and looked at me too. Then she realized, she was complaining in the same manner that she complained when her son was still a baby. All I have to say to her was " we'll all get there and he just came before us. Just remember, he was once like that to you too, taking care of all your moves because you were once a very fragile baby.."

As children, we have to realize that our parents were once as active as us. Even if they've been too harsh at one point or another, we wouldn't be where we are if not for them. Just look at the old people and start to imagine yourself with all the skin creases and wrinkles and think how would you act if you are already 90. Think again and again.

Hypoglycemia in the Elderly

Last year I wrote that Diabetes is better treated aggressively to avoid complications. True. However, when the diabetic patient becomes an elderly, this may not be so.

I had several cases admitted in the hospital, of elderly who suffered severe hypoglycemia after diligently taking their prescribed meds. One is 90 the other is 89. Hypoglycemia should be watched out among our elderly patients. They may not manifest as simple tremors or dizziness. My 90 year old patient had a very good appetite when I left her after my rounds. She even thanked me for taking care of her. However, that night her sugar started to fluctuate. I had just discontinued her hypoglycemic drugs two days prior. Her sugar dropped down to less than 50 which prompted me to give D50's. She would respond well but after several hours, the sugar would drop again. The resident on duty just continued monitoring her glucose levels and managed accordingly. However, at 4AM, the ROD called to tell me that my patient died- suddenly- seated down. Relatives said she requested to be seated down so she can eat, after several minutes, she just closed her eyes and did not breathe. Altthough she was 90, I still felt deep inside that I should have sent her home so she could have rested in the arms of all her children.

I noticed hypoglycemic agents should be used with caution when patients become 60 and above. Their response to these agents is very unpredictable. Nowadays, when I see my elderly patients whose children complain that their sugar is high, except when there are other signs and symptoms, I tell them to observe and not to feel alarmed. It is better to have higher sugar levels when you're old old. Monitoring of sugar levels is recommended.

Acne

One day, my 20 year old cousin asked me to prescribe meds for an erupting acne on her beautiful face. She is very much worried that it will ruin her pretty face. It's true a small seemingly unharmful eruption on the face becomes a big deal especially among adolescents.

How does an acene develop? You must have encountered, at least, once in your life acne eruptions especially when you were teenagers. Acne commonly starts in the early teen years because the oil glands in the body starts making more oil. In people who have acne, dead skin cells mix with the extra oil and plug up hair follicles in the skin. Bacteria that grows in the hair follicles causes more skin irritation. Remember, an open skin is a site of entry for bacteria which are not normal 'inhabitants' of the tissues under the skin.

A "whitehead" occurs when the hair follicle is plugged with oil and skin cells. If the follicle is plugged near the surface of the skin and the air touches it, it turns black and is called a "blackhead." A blackhead isn't caused by dirt. If the wall of a plugged follicle breaks, the area swells and turns into a red bump. If the follicle wall breaks near the skin surface, the bump usually becomes a pimple. If the wall breaks deep in the skin, acne nodules or cysts can form.

Things that often make acne worse include : oil-based makeup, suntan oil and hair products , stress, hormonal changes, especially during menstruation, squeezing or picking at blemishes and hard scrubbing of the skin.

Both boys and girls get acne. But it may be worse in boys because they have more skin oils. Heredity also plays a role. If your mother and father had bad acne, you may too. Your immune system plays a role too. Some people are extra sensitive to the bacteria that get trapped in their hair follicles.For many people, acne fades by the age of 25, but it can continue well into the adult years. When it happens, proper care of the face and your skin in general is a must!

Many drugstores sell products for the skin. Some over-the counter drugs such as benzoyl peroxide, resorcinol, salicylic acid and sulfur are used to treat acne. These medications are available in many forms, such as gels, lotions, creams, soaps or pads. In some people, over-the-counter acne medications may cause side effects such as skin irritation, burning or redness. Keep in mind that it can take up to eight 8 weeks before you notice an improvement in your skin.

Sometimes we recommend antibiotics, which can be very effective for treating acne. They can be taken by mouth or used on the skin in a lotion, cream or gel.

Some forms of acne can cause scars in some people. You can help reduce scarring by not squeezing or picking at blemishes. Also, avoid scrubbing your skin. When you have acne eruption, avoid touching it especially when your hands are dirty. For more concerns, it is always good to ask your doctor.

Love builds on beautiful memories....

HOMILY by Rev. Fr. Rolando V. Dela Rosa, O.P. (December 3, 2005, Caleruega)

Good morning Jerome and Cheri. Your ordeal is now over. The month of preparation for this wedding, the nervous anxiety , the worries, the sleepless nights, the endless planning, despedidas, the disagreements on schedules, choice of food, clothes and venues- all these will soon be just memories.

So now, I invite you both to relax, take it easy, concentrate on every moment of this ceremony, to celebrate the fact that you are indeed getting married in this beautiful Chapel, and to ask the Lord for the strength you need to face the challenges of married life. Focus your attention on this ceremony. The moment is unrepeatable. Savor its significance and cherish its value.

Besides, compared to all the time you spent preparing for this wedding, this ceremony is indeed very short. And judging from the length of time devoted to it, the most important part of the wedding ceremony is no longer the exchange of marriage vows, but the picture-taking. that might not be ideal, but it has practical advantages.

Cheri and Jerome, I am sure you will have beautiful pictures and videotapes of your wedding. Don't lose them, consider them as one of your priceless conjugal possessions. Together with your marriage contract. Pace your pictures in an air-tight cabinet where moths and termites and humidity could not harm them. You know why? Because wedding pictures make your love transfixed in tme, ritualized carefully to become unforgettable. these pictures will be a source of strenth and inspiration. Love builds on beautiful memories.

This is one thing many couples forget. the moment they are married, their new- found security makes them complacent. they no longer exert effort to increasing their store of past joys and happiness. They surrender to routine. Routine kills enthusiasm. Would it not be tragic if, after ten years, you start kissing eeach other not out of love, but out of sheer determination?

This is why your wedding is held within the sacrifice of the Mass. the Mass is a celebration of a beautiful memory. the Eucharist is Christ's love, transfixed and ritualized in time, so we will not forget Him. When I elevate the host and the wine, Christ speaks to you through us, saying: "Jerome and Cheri, I love you even at the risk of losing my life. This is the kind of love you must have for each other. Do this, in memory of me." In marriage, you become eucharists for one another: like Jesus, you are transfigured to become a body given, a blood shed for each other. This is why you say when you exchange vows: "I will love you for better or for worse, in sickness and in health, for richer or poorer, un til death do us part." You don't say: Until further notice.

Jerome, in a little while, you will declare to Cheri in the presence of all of us as witnesses,: "Cheri, although our marriage vows are spoken in a matter of minutes, these are promises that will last a lifetime." But, what guarantee do you have that your marriage will indeed last a lifetime? What guarantee do you have that your wedding will not end in separation? What guarantee do you have that your children will not live in a broken home? Jerome and Cheri, at this early, let me remind you: there is no human guarantee for a successful marriage.

If you rely on human strength, sooner or later you will grow weak. Even the strongest resolve and commitment become weak in time. The only guarantee for a successful marriage is the fact that marriage is not only a human invention, but a divine creation. Your falling in love was not a coincidence. It was part of God's plan. God called you to be together. And if you rely on his power and strength, if you put your faith in him, he will never disappoint you.

I remember one beautiful song that goes: "When Christ is allowed to enter our lives every storm becomes a calm, the tumult becomes peace, what cannot be done is done, the unbearable become bearable, and you pass the breaking point without breaking. For to walk with Christ is to conquer the storm." So beginning today, allow God to take charge of your life. Pray together. Pray for each other. tell him to take control of your life, for only when He is in control that you experience Peace.

In moments of difficulties, ask the Lord to make you, not only strong, firm and courageous. Ask him to give you the gift of understanding. Understanding is the prelude to forgivenness. And let's face it, everyday you will have many things to forgive each other for. We are not perfect. We commit mistakes. It is inevitable that once in a while you will hurt each other. You will even oppose each other on many issues and matters. But remember this, in marriage misunderstanding and opposition are inevitable; but quarrels are optional.

Finally, look to the example of the happily married couples around you. Their marriage may not be perfect, but they are happy, peaceful and thankful because they allowed Christ to take charge of their lives. Learn to do the same. With God at the center of your married life, there will be no mistakes, just lessons to be learned.

God bless you. Jerome and Cheri.

Headaches

Headache is a very common complaint of patients, at least in my practice. People are very worried about headaches for varied reasons: a hypertensive friend who had frequent headaches suddenly had a stroke, a friend who had headaches and was found out to have a brain tumor or a relative who died from aneurysm and complained of sudden intolerable headache. Most of these patients would want me to request for a brain CT or an MRI to see if there's something wrong with their brains.

Most of us have experienced having headaches once in a while. Others though have them almost every day. When headaches become so painful or so frequent, that's when we start to worry: could it be a symptom of a brain tumor or a warning sign of an impending stroke? How do you tell?

Chronic Headaches. The longer you've been suffering from headaches, the less likely it is that they indicate serious condition. When you suffer headaches for a period of several years with no change in intensity and no other symptoms, chances are they're harmless. There are different types of chronic headaches. Tension and Migraine Headaches.

Tension Headaches. This usually feels like a tight band around the head or a pain all over the head. This type of headache is frequent after a stressful day or improper body mechanics. Usually, it is brought about by tension due to emotional stress or problems. It is caused too by muscular spasms which produce tension in the muscles of the neck and head.

Migraine Headaches. This type of headache is much worse on one side and sometimes centered around or behind the eye. Some people see lights and different colors moving across their field of vision several minutes before the headache starts, we call this aura. Migraine headaches can be very excruciating. I had one patient who would bang her head on the wall attempting to get relief in the process. As common as it is, the etiology of migraine is still unknown, however, there is a great chance of having it when it runs in the family.

There are headaches that needs to be evaluated and warrant work- up. These three specific type of headaches should be evaluated by physicians.

Thunderclap headaches. This is a sudden and severe type of headache. This may be caused by rupture of an aneurysm or a subarachnoid hemorrhage. Aneurysms are weak areas in blood vessels which may rupture at any time. There are thunderclap headaches which are harmless, but, just the same, it is better to consult.

Some viral infections have headache as one of prodromal symtoms. When one has fever due to virus or bacteria, it maybe accompanied by headache.

There are a number of conditions that people fear:

Brain tumors. Headaches are not the very first sign of a brain tumor. Difficulty writing or speaking. weakness or clumsiness in a limb, epileptic seizures may signal trouble. Most headaches experienced by those with brain tumors are mild or sometimes non-existent.

High blood pressure. High blood pressure is a very uncommon cause of headache. Most hypertensives are asymptomatic that's why worldwide it is known as the "silent killer".

Stroke. People worry that severe headache is a stroke or will lead to one. This is not true. Symptoms of a stroke depend on which part of the brain is damaged. Neurologic symptoms such as weakness on one side or trouble with speech are common.

When you have headache, best thing to do is REST. When rest doesn't help, take a pain reliever such as Mefenamic Acid or Paracetamol. If troubles worry you much... try to find ways to solve your problems or see someone who is willing to listen.