My Father Is In The Hospital Again

Yesterday I received an email from Abel, my father collapsed while having breakfast. They rushed him to the nearest hospital in their place (Baulkham Hills Private). Workups were again done. Up to now, no diagnosis is given yet by his attending cardiologist.

I am suspecting he might be suffering from hypotension secondary to his anti-hypertensive drugs. He is on Micardis 40mg BID, Coversyl 8mg OD, Norvasc 20mg OD. This is the second time he collapsed since Micardis was added to his maintenance drugs.

He is undergoing 2D echo right now, I am hoping his heart functions are still normal. Please offer prayers for my father.

Will Our Paths Mend?

by: Abner M. Hornedo, M.D.

I've heard that we're lovers forever,
But we don't talk much anymore.
I wonder how come we can't remember,
Our love was forevermore.

Seasons changed and time departed,
Are we waiting for summer or rain?
Because of pride our hearts not united,
How long can we endure these aches and pain?

Misery and grief in my life rained,
My heart was chained and locked away.
Fallen and weak, my strenght drained,
What was a happy life became astray.

I pray to GOD that our paths will mend,
Never lose hope, faithful I remain.
For in the end after travelling the bend,
Its you and your love I hope I will regain.

Panasonic TZ1

My sister, Abigail, called me up, she is going to buy me a Panasonic Lumix TZ1. Its a good camera. The reviews are OK. I can't wait for it! Photos anyone???

Waking Up On The Wrong Side Of The Bed

Earlier this morning my temper was on a "extremely HIGH" mode. I was awakened by the loud and continuous banging on our gate by that good for nothing household help! And to think I was just beginning to have a good sleep.

Bad trip talaga! Grrrrr!

Philippines: Champion Of The World

Efren "Bata" Reyes and his long time friend and partner Francisco "Django" Bustamante are CHAMPIONS of the WORLD! They capture the first ever WORLD CUP OF POOL sponsored by partypoker.com.

MABUHAY KAYO! MABUHAY ANG PILIPINAS!

Semis For Team Philippines

TEAM PHILIPPIPNES

Team Philippines composed of Efren Reyes and Django Bustamante made it to the semi-finals of the party poker.com World Cup of Pool beating the Czech Republic 9-6. But not after some scary moments. The number one seeds raced into an early 3-0 lead against unseeded Czech Republic but then only won one of the next seven racks as the Czechs gained a 6-4 advantage.

Finally the Filipinos displayed their mental strength to win the next 5 games to clinch the match 9-6.

They will soon face Ortmann and Engert of Germany in the semifinal round.

Mabuhay kayo Efren at Django!

Primary Insomnia

Primary insomnia is sleeplessness that is not attributable to a medical, psychiatric, or environmental cause. The diagnostic criteria for primary insomnia from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) are as follows:

A) The predominant symptom is difficulty initiating or maintaining sleep or nonrestorative sleep for at least 1 month.

B) The sleep disturbance (or associated daytime fatigue) causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C) The sleep disturbance does not occur exclusively during the course of narcolepsy, breathing-related sleep disorder, circadian rhythm sleep disorder, or parasomnia.

D) The disturbance does not occur exclusively during the course of another mental disorder (eg, major depressive disorder, generalized anxiety disorder, delirium).

E) The disturbance is not due to the direct physiologic effects of a substance (eg, drug abuse, medication) or a general medical condition.
The International Classification of Sleep Disorders does not recognize a category of primary insomnia but discusses the following 3 free-standing insomnia subgroups:

1. Psychophysiological insomnia
2. Idiopathic insomnia
3. Sleep state misperception

The disorder is chronic by definition (ie, lasting at least 1 mo).

Causes: Exclusion of other common causes is required to make the diagnosis of primary insomnia.

Medical causes:
1. Chronic pain
2. Primary sleep disorders (eg, sleep apnea, periodic limb movements, restless legs syndrome)
3. Dyspnea from any cause
4. Pregnancy
5. Drug use or withdrawal (eg, selective serotonin reuptake inhibitors, stimulants, antihistamines, caffeine, diet pills, herbal preparations containing ma huang, anticonvulsants, steroids)

Psychiatric and/or psychological causes:
1. Mood disorders (eg, depression, mania)
2. Anxiety disorders (eg, generalized anxiety, panic attacks, obsessive–compulsive disorder)
3. Substance abuse (eg, alcohol or sedative/hypnotic withdrawal)
4. Major life stressors and/or events

Environmental causes:
1. Noise
2. Jet lag or shift work
3. Bedroom too hot or cold

Treatment: Pharmacologic treatment usually provides rapid symptom relief, but controlled studies of long-term treatment have not been conducted.

1. Nonprescription drugs:

The active agent in many of these over-the-counter medications is one of the sedating antihistamines. They are generally safe but have anticholinergic adverse effects such as dry mouth, blurred vision, urinary retention, and confusion in older patients, which can be potentially more serious in patients with dental caries, glaucoma, prostatic enlargement, and dementia (or delirium), respectively.

They are also minimally effective in inducing sleep and may reduce sleep quality. Consequently, discourage patients from using them on a routine basis.

Discourage the use of various herbal preparations (eg, herbal tea) and so-called nutritional substances because of the lack of evidence in their support.

Studies have shown that melatonin may be useful for short-term adaptation to jet lag or other circadian rhythm sleep disorders. The effectiveness of melatonin for chronic insomnia is less clear. A recent study showed that melatonin did not produce any sleep benefit in patients with primary insomnia. Melatonin is sold over the counter and, therefore, is not controlled by the Food and Drug Administration (FDA). The optimal dose and its long-term adverse effects also are not known.


2. Prescription drugs:

Hypnotics and benzodiazepines (BZDs) are the mainstays of short-term treatment of primary insomnia.

Basic principles for rational treatment of insomnia are to use the lowest effective dose, to use intermittent dosing (2-3 nights per wk), to use for short term (2-3 wk at a time), to discontinue after slow taper if the patient has been taking it regularly, and to use agents with short and/or intermediate half-life to minimize daytime sedation.

Pharmacokinetic properties and risk-benefit ratio are the key factors in selecting the most appropriate medication.

Another Sleepless Night

I don't know why I can't sleep last night. So many things going thru my mind. I don't know what to do anymore... I don't want to take those relaxants, it's addictive. I hate drugs!

Why Result To Cheating

The recent nursing board examination brouhaha is occcupying airtime. It is one of the major news seen on TV, heard over the radio and read on papers and the internet today.

But what is the real impact of this to our society and country as a whole? Who are the real losers here? Did the so called "whistle blowers" (i presume they all flunked the test), the ones who exposed the fiasco, got the justice they deserved? Who is really to blame for this?

Cheating during examinations is a filipino students' way of life. Its a harsh reality, a horrifying fact. Truth really hurts but whoever is not guilty of cheating during examinations and tests while we were all students, may throw the first stone at us (me included).

But do we really need to cheat in order to pass? I realized back then, when I was in medical school, that it is useless to pass an examination without anything being retained in my brain. It came clear to my mind that I will be the ultimate loser if I cheat. Sure I will pass the subject, the course, but what kind of doctor will I become? I surely cannot ask for my classmates help when I am treating my patients. So I strived to study hard for me to become what I am now.

The real losers here are the students themselves especially the ones who really did not cheat during the board exams. We cannot remove anymore the clouds of doubt in them. They will always (I hope not for the rest of their lives) be haunted by the fact that other people will think they passed the exams becaused they cheated. The parents of these students are losers as well, imagine the anguish they are getting from this. The nursing association and our country are losers too, credibility will always be in question here.

For those who blew the whistle, I think they already got what they wanted. They already ruined the integrity of the nursing board, the professional regulation commission and the integrity of the filipino nurse as a whole. You already inflicted so much pain and suffering to many of your supposed to be colleagues and their families. My advise for you is study harder retake the exam and pass it , do not blame others for your shortcomings. I hope you are all straight during your student days and you did not cheat! I doubt it! You are not to be blamed here but you ignited all of this. Thanks to you (this is a sarcasm)!

Again, no one is to be blamed except for those corrupt people up there who are in charge of this examination. I am certainly sure that money is the cause of this Remember when there is smoke, there is fire! There must be some truth in these allegations although it will be real hard to prove it (lucky you demons!). I hope you can still sleep soundly at nights and I hope you can stomach that what you are feeding your family came from dirty money.

We don't really need to cheat in order to pass an examination, I already proved it myself. "Mag aral kayo mabuti at huwag puro lakwatsa at pasarap sa buhay para wag kayo pulutin sa kangkunggan."

Despite The Rain

Its raining cats and dogs here this morning, I have nothing to do all day again except to click on my mouse and type on my keyboard. Its been two weeks since I got my wireless broadband from SMART BRO. Good thing I am one of the "10%" of those having good service from them.

My connection speed now taken from testmy.net is:

:::.. Download Stats ..:::
Download Connection is:: 350 Kbps about 0.35 Mbps (tested with 386 kB)
Download Speed is:: 43 kB/s
Tested From:: http://testmy.net/ (Server 2)
Test Time:: 2006/08/21 - 2:57pm
Bottom Line:: 6X faster than 56K 1MB Download in 23.81 sec
Tested from a 386 kB file and took 9.047 seconds to complete
Download Diagnosis:: Awesome! 20% + : 59.82 % faster than the average for host (204.22)
D-Validation Link:: http://testmy.net/stats/id-RYZU6JML9
User Agent:: Mozilla/4.0 (compatible; MSIE 6.0; Windows NT 5.1; SV1) [!]


Please be informed that I am, in any way, not connected or being paid by Smart to blog for them. Please visit the Smart Wi-Fi Chronicles so that you could know what I am talking about.

My Apologies Jim

After reading Jim Paredes' blog, I felt so wrong quoting the Philippine Daily Inquirer's article on Jim Paredes giving up on RP.

My apologies to you sir. Now I really know the truth. I'll delete that entry right away. I share your feelings being separated from your family, as I am separated from my family as well, they are also in Sydney and I am here in the Philippines right now.

Good luck in all future endeavors.

Tennis / Badminton Elbow

Lateral epicondylitis, or tennis elbow, is a commonly encountered problem in orthopedic practice.

Problem:

Lateral epicondylitis is an overuse injury involving the extensor/supinator muscles that originate on the lateral epicondylar region of the distal humerus.

Frequency:
Lateral epicondylitis has been demonstrated to occur in up to 50% of tennis players. However, this condition is not limited to tennis players and has been reported to be the result of overuse from many activities. Lateral epicondylitis is extremely common in today's active society.

Etiology:

Any activity involving wrist extension and/or supination can be associated with overuse of the muscles originating at the lateral epicondyle. Tennis has been the activity most commonly associated with the disorder. The risk of overuse injury is increased 2-3 times in players with more than 2 hours of play per week and 2-4 times in players older than 40 years. Several risk factors have been identified, including improper technique, size of racquet handle, and racquet weight.


Pathophysiology:

Many proposed etiologies for this condition have involved inflammatory processes of the radial humeral bursa, synovium, periosteum, and the annular ligament. However, in 1979, Nirschl and Pettrone attributed the cause to microscopic tearing with formation of reparative tissue (ie, angiofibroblastic hyperplasia) in the origin of the extensor carpi radialis brevis (ECRB) muscle. This microtearing and repair response can lead to macroscopic tearing and structural failure of the origin of the ECRB muscle.

Concomitant intra-articular lesions (eg, loose bodies, synovitis, ulnohumeral osteophytes, chondral lesions) have been visualized during elbow arthroscopy in patients with lateral epicondylitis. However, while concomitant intra-articular pathology has been noted, this process is currently considered an extra-articular process.

Clinical:

Patients present complaining of lateral elbow and forearm pain exacerbated by use. The typical patient is a man or woman aged 35-55 years who either is a recreational athlete or one who engages in rigorous daily activities.

Upon examination, the patient has a point of maximal tenderness just distal (5-10 mm) to the lateral epicondyle in the area of the ECRB muscle. Wrist extension or supination (but not flexion or pronation) against resistance with the elbow extended should provoke the patient's symptoms. Another helpful test is the chair raise test. The patient stands behind their chair and attempts to raise it by putting their hands on the top of the chair back and lifting. In patients with lateral epicondylitis, pain results over the lateral elbow.


Medical therapy:

Nonsurgical treatment is the mainstay of care for patients with lateral epicondylitis. The goal of initial treatment is cessation of the offending activity. Rest, use of a counterforce brace, and nonsteroidal anti-inflammatory drugs (NSAIDs) often provide relief of symptoms. Often, wrist splinting and/or corticosteroid injections are necessary.

When the patient is free of pain through a full range of motion, begin strengthening therapy in a very slow and progressive way. When the patient regains strength and nears resumption of activity, place the emphasis on preventing future irritation (eg, correct technique or address equipment concerns in athletes who participate in racquet sports, modify jobs or activities in patients who are not athletes).

Despite some excitement about the use of extracorporeal shock wave therapy, a recent prospective, randomized, blinded, multicenter European trial showed no benefit of this intervention over placebo.

Surgical therapy:

A myriad of surgical procedures has been described for the treatment of lateral epicondylitis. However, most surgical procedures involve debridement of the diseased tissue of the ECRB muscle with decortication of the lateral epicondyle. This procedure has been performed through open, percutaneous, endoscopic, and arthroscopic approaches. While the classic open approach provides excellent reproducible results, the mentioned minimally invasive approaches are reported to allow earlier rehabilitation and resumption of activities.

Homicidal

Last night I can't sleep. My right elbow is still hurting. This time my right shoulder joined the party of pain. It was nearly 5 in the morning when my eyes finally succumbed to sleepiness. All nightlong, I am just waiting for thieves to attack, I am ever ready with my trusted Colt .45 cal 1911. Ready to shoot and kill if necessary.

Robbery in our place became rampant nowadays. So you robbers out there watch out. I am going to get you!

Can't Upload Pictures

What is happening to blogger? I can't upload pictures. Anybody with the same problem?

Kawasaki Disease

Kawasaki disease is an acute febrile vasculitic syndrome of early childhood. While at the Tokyo Red Cross Medical Center in Japan, Tomisaku Kawasaki reported 50 children in 1961-1967 who presented with fever, rash, conjunctival injection, cervical lymphadenitis, inflammation of the lips and oral cavity, and erythema and edema of the hands and feet. Fatalities occurred in children younger than 2 years when they were improving or after they had seemingly recovered. Postmortem examinations revealed complete thrombotic occlusion of coronary-artery aneurysms (CAAs) with a myocardial infarction (MI) as the immediate cause of death.

Kawasaki disease is the leading cause of acquired heart disease in children in the developed world and may be a risk factor for adult ischemic heart disease.

The etiology of Kawasaki disease is unknown. Increasing evidence supports an infectious etiology for Kawasaki disease; however, whether the inflammatory response results from a conventional antigen or a superantigen continues to be debated.

Kawasaki disease has 3 stages, as follows:

Acute stage (1-11 d)

High fever (temperature >104°F)
Irritability
Nonexudative bilateral conjunctivitis (90%)
Anterior uveitis (70%)
Perianal erythema (70%)
Acral erythema and edema that impede ambulation
Strawberry tongue and lip fissures
Hepatic, renal, and GI dysfunction
Myocarditis and pericarditis
Lymphadenopathy (75%), generally a single, enlarged, nonsuppurative cervical node measuring approximately 1.5 cm

Subacute stage (11-30 d)

Persistent irritability, anorexia, and conjunctival injection
Decreased temperature
Thrombocytosis
Acral desquamation
Aneurysm forms
Convalescent or chronic phase (>30 d)
Expansion of aneurysm
Possible MI
A tendency for smaller aneurysms to resolve on their own (60% of cases)

Physical:

Patients with classic Kawasaki disease must have 5 of the following symptoms, with fever an absolute criterion:

1. Fever, lasting more than 5 days and refractory to appropriate antibiotic therapy
2. Polymorphous erythematous rash
3. Nonpurulent bilateral conjunctival injection
4. Oropharyngeal changes, including diffuse hyperemia, strawberry tongue, and lip changes (eg, swelling, fissuring, erythema, bleeding)
5. Peripheral extremity changes, including erythema, edema, induration, and desquamation
6. Nonpurulent cervical lymphadenopathy
Other findings may include the following:

General - Irritability
Cardiac - Coronary aneurysms, pericardial effusion, myocarditis, CHF
Neurologic - Stiff neck secondary to aseptic meningitis, facial palsy, cerebral infarction
Renal - Sterile pyuria, proteinuria, nephritis, acute renal failure
Musculoskeletal - Joint involvement (arthralgias or arthritis)
Pulmonary - Pleural effusion, infiltrates
GI - Abdominal pain, diarrhea, hepatitis, obstructive jaundice, hydrops, pancreatitis, gall bladder distention
Tissues - Meatitis, vulvitis, urethritis
Ophthalmologic - Conjunctivitis, uveitis
Dermatologic - Peripheral extremity gangrene, pustules, erythema multiforme–like lesions, perianal desquamation, macules, papules, measleslike rash, scarlet fever–like erythema, and induration at the site of bacille Calmette-Guérin (BCG) inoculation (commonly observed in Japan); pustulovesicular skin eruption in a child with probable Kawasaki disease; Beau lines associated with Kawasaki syndrome after the disease resolves

Up to 10-45% of published cases have incomplete or atypical clinical presentations. The 2 most commonly missing findings are cervical lymphadenopathy and polymorphous rash.

Mucous-membrane changes are the most common manifestations of Kawasaki disease, occurring in more than 90% of patients with either typical or atypical forms of the disease.

No specific laboratory test exists; however, certain abnormalities coincide with various stages.

Treatment:

The main goal of treatment is to prevent coronary artery disease and relieve symptoms. Full doses of salicylates (aspirin) and intravenous gammaglobulin are the mainstays of treatment.

1. Admit all patients to the hospital for intravenous gammaglobulin and observation until fever is controlled.
2. Closely monitor cardiovascular function.
3. Patients with small aneurysms must take aspirin.
4. Dipyridamole is indicated in patients with larger aneurysms.
5. Patients taking long-term aspirin therapy should receive an influenza vaccination to protect against Reye syndrome.

PC At 25 Years

August 1981 since IBM launched the "first" PC, the 5150. It only had 40 kb of internal memory 16 kb of RAM in it and weighed as much as 20 lbs! Amazing how technology has gone a long way. Good thing the children of today didn't have to use the 5150. I just can't imagine using it myself.

HAPPY 25th BIRTHDAY COMPUTER!

I Love Her.... Voice!

She is the Philippines' up and rising star jazz singer. Man, you'll love her voice!

You should get a copy of her album Cafe Bossa.

The Philippines Is

I chanced upon this blog obviously from a filipino like me. I admit it sounds crazy but most of these are true, here goes.....

THE PHILIPPINES IS…..

50. Where the most happening places is not where the party is. Instead it’s where the gang wars happen, where women strip and where the people overthrow a president.

49. Where even doctors, lawyers and engineers are unemployed.

48. Where everyone has his personal ghost story.

47. Where mountains like Makiling and Banahaw are considered as holy places.

46. Where everything can be forged.

45. Where the school is considered the second home and the mall considered as third.

44. Where Starbucks coffee is more expensive than gas.

43. Where every street has a basketball court and every town only has one public school.

42. Where all kinds of animals are edible.

41. Where people speak all kinds of languages, and still call it Tagalog.

40. Where students pay more money than they will earn afterwards.

39. Where call center employees earn more money than teachers and nurses.

38. Where driving 4kms can take as much as 4hours.

37. Where flyovers bring you from the freeway to the side streets.

36. Where the tourist spots is where Filipinos do not (or cannot) go.

35. Where the personal computer is mainly used for games and Friendster.

34. Where all 13 year olds are alcoholic.

33. Where colonial mentality is dishonestly denied!

32. Where 4am is not even considered bed time yet.

31. Where people can pay to defy the law.

30. Where everything is spoofed.

29. Where even the poverty-stricken get to wear Ralph Lauren and Tommy Hilfiger.

28. Where honking of car horns is a way of life.

27. Where being called a bum is never offensive.

26. Where flood waters take up more than 90 percent of the streets during the rainy season.

25. Where everyone has a relative abroad who keeps them alive.

24. Where crossing the street involves running for your dear life.

23. Where wearing your national colors make you “baduy”.

22. Where billiards is a sport, and darts is a bar game.

21. Where even the poverty-stricken have the latest cell phones. (gsm - galing sa magnanakaw)

20. Where insurance does not work.

19. Where water can only be classified as tap and dirty… clean water is for sale (35pesos/gallon).

18. Where the church governs the people and where the government makes the people pray for miracles. (AMEN TO THAT!)

17. Where University of the Philippines is where all the weird people go. Ateneo is where all the nerds go. La Salle is where all the Chinese go.. College of Saint Benilde is where all the stupid Chinese go, and University of Asia and the Pacific is where all the irrelevantly rich people go.

16. Where fastfood is a diet meal.

15. Where traffic signs are merely suggestions not regulations.

14. Where all the trees in the city are below 6ft.

13. Where being held up is normal. It happens to everyone.

12. Where kids dream of becoming pilots, doctors and basketball players.

11. Where rodents is a normal house pet.

10. Where the definition of traffic is the ‘non-movement’ of vehicles.

9. Where the fighter planes of the 1940’s are used for military engagements, and the new fighter planes are displayed in museums.

8. Where being an hour late is still considered as punctual.

7. Where cigarettes and alcohol are a necessity, and where the lottery is a commodity.

6. Where soap operas tell the realities of life and where the news provides the drama.

5. Where actors make the rules and where politicians provide the entertainment. (kung gusto mo mapikon, watch the news)

4. Where finding a deer on the road will be a phenomenon. (may deer dito? seryoso kayo?)

3. Where people can get away with stealing trillions of pesos, but not for a thousand.

2. Where Nora Aunor is an acclaimed actress and Boy Abunda is the best talk show host.

1. Where everyone wants to leave the country! (ang saya-saya!)

My Elbow Is Hurting

Why can't I take a rest from badminton? This I can't answer even up to now. Is it the camaraderie amongst the group? Is it the enjoyment I am getting from playing (even if most of the time I lose)? Is it the calories I get to burn during this strenous exercise?

Maybe the answer to all of of these is an austounding YES.

My right elbow is hurting, but this will not stop me from smashing tomorrow. See you in COURT!

WellPatch Cough & Cold Vapor Pads Recalled

Yael Waknine


August 2, 2006 — The US Food and Drug Administration (FDA) and The Mentholatum Company have notified consumers regarding the nationwide voluntary recall of a topical cough suppressant (WellPatch Cough & Cold Soothing Vapor Pads) due to the risk for pediatric ingestion associated with its use.

The over-the-counter vapor patch contains camphor, eucalyptus oil, and menthol. According to the package labeling, it may be used in children aged 2 years and older and should be placed on the throat or chest to allow vapors to reach the nose and mouth.

However, such placement also enables young children to remove the product and place it in their mouths, according to an alert sent yesterday from MedWatch, the FDA's safety information and adverse event reporting program.

Adverse events associated with swallowing or chewing on products with camphor or eucalyptus oils have ranged from minor symptoms (eg, oral burning sensation, headache, nausea/vomiting) to more severe and potentially life-threatening reactions such as seizures. According to a company news release, no serious adverse events have been reported to date.

A Big Joke!

Virgilio Garcillano to run for congress! The controversial former COMELEC commissioner, famous for the "HELLO GARCI tape scandal" might be fielded by the administration to run against Rep. Nereus Acosta (of the Liberal Party) to be the Congressman of the 1st district of Bukidnon.

This shows how the Philippines is comparable to HELL! Demons are lurking everywhere! At least when we die we are already accustomed to live in hell!

PLEASE GET ME OUT OF HERE!!!!

My New Toy

My New Motorola V3i with iTunes

Cool Phone! I wish I could hack this phone to make it more interesting.