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.

Age- Related Eye Diseases

Blurring of vision and loss of balance are only two of the symptoms reported by my elderly patients in the clinic. These symptoms affect their activities of daily living and makes them less confident to do regular household tasks.

The Philippine National Survey on Blindness conducted in 2004 reported the top ten causes of blindness which include the following:

Cataract. This is the most common cause of visual loss in Filipinos (62.1%) and is very commom in the lederly. Age- related cataracts develop in two ways: (1) clumps of protein reduce the sharpness of the image reaching the retina and (2) the clear lens slowly changes to a yellowish/ brownish color, adding a brownish tint to vision.

Errors of Refraction. This occurs when light rays don't focus on the retina caused by imperfectly shaped eyeball, cornea and lens. There are four types of EOR, myopia, hyperopia, astigmatism and presbyopia.

Myopia- or nearsightedness is caused by long eyeball or steep cornea. Patient sees close objects clearly while distant objects appear blurred.

Hyperopia- or farsightedness is caused by shorter than normal eyeball, causing distant objects to look clear while near objects look blurred.

Astigmatism- or distorted vision is caused by abnormal curvature of the cornea. One area of the cornea may be curved more than the other.

Presbyopia- or aging eyes. The aging lens become rigid and can't change its shape easily thus making it difficult to read at close range.

Glaucoma. This is the third most leading cause of blindness. It shows characteristic optic disc excavation or cupping, visual field defects and elevated intraocular pressure. Glaucoma cannot be cured but if diagnosed early and treated immediately disease progression may be delayed.

Diabetic Retinopathy. This is a complication of diabetes. It occurs when diabetes damages the tiny blood vessels inside the retina. Vision loss is caused by macular edema or blood leak into the center of the eye also called proliferative retinopathy.

Age- related Macular Degeneration. A disease that blurs the sharp, central vision one needs for "straight-ahead" activities such as reading, sewing, and driving.

It has been noted that taking a specific high- dose formulation of antioxidants and zinc significantly reduces the risk of advanced age related macular degeneration and its associated vision loss. It is recommended therefore for the lederly to take 500mg of Vit. C, 400IU of Vit. E, 15 mg or equivalent to 25,000IU of Vit. A, 80 mg of Zinc and 2 mg of Copper once daily.

Not all of these causes of blindness are preventable and curable hence, awareness that something can be done to improve the quality of the lives of those afflicted should be emphasized.

The Diabetes Legacy

Once again, Dr. R. Fernando, an 80 year old diabetologist, staunch believer of treating pre-diabetics aggressively, encouraged us to to do the same in our practice.

In my once a month wellness day in my private practice, I noticed that most of the patients have fasting capillary blood sugar between 103-140. They are either known diabetics or "healthy" individuals. I have always emphasized on strict lifestyle modification.

What convinced me really is the idea that perhaps diabetes is a disease of the lipids and not the sugar or perhaps disease of the heart and consequently dysglycemia. Truth is, most of my patients who developed diabetes, had, in the past, impaired lipid levels and they were not followed up strictly, so that 5 to 10 years after they come to me already with high sugar levels and a coronary problem.

It is a cry for us Family Physicians to move. We may have come 100 years earlier but who knows, what if treating those 90 and above will lower the incidence of diabetes or perhaps delay its onset? Wouldn't it be nice if the world has less diabetics?

This calls for an evidence based research and I will begin in my patients, today and now....!

Ovarian Cysts

I was almost successful in counseling a depressed patient when she came back to me again in tears!

During her follow up a week ago, I saw her in a cheerful aura with no signs of anxiety or despair. She has been worried of her sister's condition and has been compalining of mild colicky pain on her left lower quadrant. Previous work- up for UTI or kidney stones were normal. She has a history, though, of uterine polyps and endometriosis as shown in her ultrasound done a year ago. Thinking that there is progression of the condition, I requested for a repeat transrectal ultrasound as she has no sexual experience at her age of 57.

When she saw the report of the ultrasound, she was very happy. While waiting for the gynecologist, she was already thanking God because there were no uterine polyps nor endometriosis seen except for bilateral ovarian cysts measuring 1x1 cm each. Her happiness subsided when the gynecologist told her " we have to make sure it's not cancer, so let's do CEA, AFP and B-HCG titers...". She wanted further explanation but the doctor gave her the request and told her to have it done before she goes back to her clinic gesturing her to leave. She went straight to my clinic in tears thereafter.

Are ovarian cysts cancerous in nature?

Most ovarian cysts are functional, meaning, they're benign. It is common in women of all ages caused by failure of an ovarian follicle to rupture and release the egg during ovulation. The fluid remains and can form a cyst in the ovary. While cysts may be found in ovarian cancer, ovarian cysts typically represent a normal process or harmless (benign) condition. Requesting for cancer markers which cost a lot is really not necessary when symptoms are not proportionate to or referrable to an ovarian malignancy.

On top of that, my patient has a very melancholic personality. She is currently recuperating from depression and now another depressing diagnosis is posed on her! I had to go back to educating her, counseling her and making her understand that her condition is benign and there is no need to worry and that the best thing to do is observe... at the moment.

I really hope all doctors look at the patient and not the ancillary procedure. If her concern was explored prior to telling her that her cysts may be cancer, we could have spared her of another depressive moment. I understand that the gynecologist only wants to make sure that her two tiny cysts are not cancerous but she could have explained to her statistics first before outrightly telling her , "let's make sure, it's not cancer".

I know it's hard to be in the surgical field as I heard a gynecologist friend telling me that if given the chance to go back, she wouldn't be a gynecologist. She said her children suffer the most when she leaves in the middle of the night to deliver babies. I told her though not to feel sorry as God made her an instrument to bring new life in the world but to also learn to prioritize. Well, better said than done of course, especially from a family physician.

Seniors in Action!

It was a hot and humid afternoon but they were all there. Ladies in different shades of black and gray, men clad in white polo shirts with caps to cover their baldness; they all went to the Marikina City Hall’s quadrangle to attend the first Mini- Convention for seniors entitled “Mga Pagbabago...Sa Paglipas Ng Panahon”.

When I gave the talk on Physiologic Changes of Aging, they intently listened although after 30 minutes I saw some of them with drooping eyes and others really sleeping right in front of me. But what’s really moving is to see 81 yrs old and above smiling and looking at me as if attentively listening. It made me think of myself 40 or 50 years from now. What kind of LOLA will I be?

Dr. Tricia Bautista gave a good workshop on dementia screening and test for sensory functions. Thanks to the UST Department of Family Medicine who brought their Wellness Caravan to Marikina for the event. The presence of several health care groups also made the activity alive. The Home Health Care conducted a mind game with influenza and pneumonia vaccines offered at discounted prices. Thanks to the ever supportive Dr. Jean Guno. MSD did a bone densitometry screening to check for osteoporosis which surprised my father-in-law whom we found out to have osteoporosis, he thought only women can have the disease. Nestle (Nutren products) did nutritional assessment.

Mayor MC Fernando graced the event as head of the City Womens Council of Marikina. I’d like to express my sincerest gratitude to Ms. Mel David and Mdm. Letty Cabungcal for inviting me to this affair. It was fun rubbing elbows with ‘the’ MCF of Marikina. I was happy though when she said “ Let’s do this on a regular basis.” Way to go Marikenos! To think that I am only married to a Marikeno!