FJ, Volume 22, Number 16
Aug 22 - Sept5, 2008
I received the following 2 emails from my parents which had been circulated among quite a few pinoys:
1) “A NEEDLE CAN SAVE THE LIFE OF A STROKE PATIENT -
From a Chinese Professor....When stroke strikes, the capillaries in the brain will gradually burst..... stay calm. No matter where the victim is, do not move him...Because, if moved, the capillaries will burst. Help the victim to sit up and then the blood letting can begin. If you have...an injection syringe that
would be the best. Otherwise, a sewing needle or a straight pin will do...”
The email then describes a process to prick the fingers and ears of the patient and induce blood-letting:
“After a few minutes the victim should regain consciousness...Wait till the victim regains his normal state without any abnormal symptoms then take him to the hospital. Otherwise, if he was taken in the ambulance in a hurry to the hospital, the bumpy trip will cause all the capillaries in his brain to burst. 'I learned about letting blood to save life from Chinese traditional doctor, Ha Bu Ting, who lives in
Sun Juke. Furthermore, I had practical experience with it. Therefore, I can say this method is 100% effective.”
The email describes a scenario that occurred in 1979 where the process worked exactly as described:
“...There were no ill after effects....On the other hand, the usual stroke victim usually suffers Irreparable bursting of the brain capillaries on the way to the hospital. As a result, these victims never recover.' ...Therefore, stroke is the second cause of death...If we can all remember this blood letting method and
start the life saving process immediately, in a short time, the victim > will be revived and regain 100% normality....IF POSSIBLE PLEASE FORWARD THIS AFTER READING . YOU NEVER KNOW IT MAY HELP SAVE A LIFE FROM STROKE.”
I don’t usually respond to these types of emails (let alone forward them!), but I felt compelled to respond to this one because of the dangers associated with it. Here’s my response:
This is dangerous and unfounded. As a Canadian-trained and licensed family physician with additional training in neurology and stroke rehabilitation, I wouldn't advise this. If the person gets better, it might and very likely occurred because it was only a TIA (transient ischemic attack) and not at all related to blood-letting. It has been medically proven that "all the capillaries in the brain" do NOT burst upon arrival to the hospital. It is not plausible that a "bumpy car ride" would burst all the capillaries and worsen the situation. Any bump in a road is NOTHING compared to what is occurring in the brain already, and is only as bumpy as being transported on a stretcher within the hospital. None of the various radiological tests (CT scans/MRIs/PET scans/arteriography) and post mortem (autopsies) examinations have shown that these activities cause any damage, BECAUSE THERE IS NOT THIS TYPE OF DAMAGE SEEN IN THE TISSUE. Also, it does not make sense that a neurological disease which presents on its own, would be miraculously reversed to "100% normality", let alone due to loss of a few drops of blood. If that were the case, why not prick all babies for blood to PREVENT the stroke process from happening and eradicate the disease from humanity??!
STROKES ARE LOCALIZED INFARCTS (DEATH OF THE BRAIN TISSUE) IN THE BRAIN FROM LACK OF OXYGEN TO THE TISSUE DUE TO EITHER EMBOLI (BLOCKAGE OF A BRAIN ARTERY FROM CLOTS FORMED ELSEWHERE IN THE BODY), THROMBOSIS (CLOT FORMED AT THE SITE OF THE BRAIN ARTERY), OR HEMORRHAGE (A BLEED FROM THE BLOOD VESSEL IN QUESTION). THE VARIOUS SYMPTOMS SEEN DEPEND ON THE AREA OF THE BRAIN AND BLOOD VESSEL AFFECTED. THERE IS NO RELIABLE WAY TO DETERMINE WHAT TYPE OF STROKE/TIA YOU ARE FACING WITHOUT DIAGNOSTIC IMAGING (CT SCAN, MRI, ETC), SO BLOOD-LETTING, EVEN IF IT WORKED FOR ONE TYPE, WOULD NOT WORK FOR THE OTHERS AND THUS IS AT BEST, POTENTIALLY DANGEROUS/FATAL TO THE PERSON. THIS IS BECAUSE MULTIPLE FACTORS, SUCH AS THE SIZE OF THE INFARCT, LENGTH OF TIME BEFORE ADEQUATE TREATMENT, AND GENERAL HEALTH OF THE INDIVIDUAL, DETERMINE THE OUTCOME. IF YOU ARE WASTING TIME WITH THE PROCEDURE DESCRIBED, YOU ARE SERIOUSLY WORSENING THE CHANCES OF A GOOD OUTCOME. THE TIME COULD BE SPENT GETTING THE PATIENT TO A HOSPITAL WHERE S/HE COULD BE RAPIDLY DIAGNOSED AND TREATED.
Please beware of any "treatment" that:
- makes blanket statements about a disease that has many different causes and VERY different management approaches,
- claims anything 100%,
- gives vague evidence,
- does not provide any plausible mechanism of action (eg. WHY would ear pulling work in this situation when a bumpy ride will worsen things?)
- deals with a life-and-death situation
- does not give full disclosure about the other treatments available and only presents one perspective
- comes to you without any references to back it up ("a Chinese professor"???)
Feel free to forward this back to the person who sent this to you as well as anyone you may have sent this to. It may save a life, or rather, it may avoid an unnecessary death.
Denise M. Viardo Koh, BSc, MD, CCFP, MPH
ps. Real medical doctors' (the ones with MDs aka medical degrees) credentials can be confirmed at the licensing body where they practice medicine.
2) “I got this e-mail from a friend and I have doubts about the efficacy of these exercises
I would like to ask the opinion of your daughter Dr. Denise Koh about this claims. Why do we have to believe everything that the Indian gurus tell us?”
The forwarded email was titled, “Health in Your Hand: Seven Mudras for Amazing Health Benefits” and detailed 7 hand positions/exercises which claimed numerous health benefits:
“...enhances the knowledge. ...increases memory power and sharpens the brain...Enhances concentration and prevents Insomnia...cure all psychological disorders like Mental, Hysteria, Anger and Depression ... reduces all physical weaknesses.
It helps to increase the weight for weak people ...improves the complexion of skin and makes the skin to glow ...It makes the body active by keeping it healthy ...balances the water content and prevents all diseases which come due to lack of water...retains clarity in blood by balancing water content in the body...Prevents the pains of Gastroenteritis and Muscle Shrinkage...prevents all the diseases that occur due to the imbalance of the air....cures Rheumatism, Arthritis, Gout, Parkinson's disease and paralysis without any medicine...useful for Cervical Spondilytis, paralysis to face and catching of nerve in neck ...corrects the disorder of gas in the stomach ...reduces the dullness in our body...relieves an earache within 4 or 5 minutes...useful for the deaf and mentally challenged, but not for inborn ones....sharpens the center in thyroid gland...reduces cholesterol in body and helps in reducing weight...reduces anxiety ...corrects indigestion problems... improves the power of life. Weak people become strong....reduces the clamps inblood vessels....improves immunity ...Improves the power of eyes and reduces eye related diseases...removes the vitamin deficiency and fatigue... regulates the excretory system... regulates diabetes ...cures constipation and piles...helps excreting the normal waste regularly ...benefits the heart. It works like injection in the reduction of heart attack. It is as powerful as sorbitate tablet. It reduces the gas content in body. ..strengthens the heart and regularizes palpitation ...regulates excretory system...redeems gastric trouble ... generates heat in our body.... stops production of phlegm and gives power to lungs ...cures severe cold and bronchial infection ...invigorates the body ....It is amazing but true.. If you want to see the results, start today!”
My response:
Hi,
I really don't have much to say about these exercises. In my medical training, I would classify this type of "health care" under "Alternative Medicine," which we didn't go into much detail about. The problem with a lot of Alternative Medicines/Therapies etc, is that most of these practices are anecdotal and are not supported by standardized research or regulated by well-established authorities. For example, a lot of the "Herbal Supplements" are not regulated, and, because they are not listed under "Drugs", they don't need to pass the same standards/regulations that our drugs do. So, the companies don't even have to put the amount they say they are putting in the bottle. And I remember reading about some testing that was done (it was something like 20/20 or 5th estate) on many of these supplements which showed that many of them contained dangerous additives, wrong dosages, and some didn't contain ANY of what they were claiming to contain! Many of these treatments/therapies/herbs sell easily because the public has a general fear of medical science and research. They think that synthetic medications are inherently bad for you, and herbs are "natural" and therefore harmless. I approach any practice or supplement (synthetic or "herbal") the same--I try to evaluate who is promoting it and what type of research, if any, supports it. We have to weigh these things against the potential harm they may cause.
In this particular case, I would say that the exercises don't seem terribly harmful, so if a person believes they may work, I wouldn't tell them not to. But in this case, I am relying more on the placebo effect to do good than on any basis the exercises claim; I believe that if a person believes in a therapy, they have a much better chance of responding better, whether the therapy works or not. However, if a person were going to rely on these exercises and refuse any therapies/treatments that have much stronger research behind them, I would strongly urge the person to try at least both.
Superstition isn't always harmful, but ignorance almost always is.
Cheers,
Denise
Friday, September 05, 2008
Saturday, August 23, 2008
Men's Plumbing Problems cause Embarrassment
Housecall with Dr. Denise
urban NDN - August 2008 - issue 3
My 62 year-old grandpa has been complaining of problems with urination. He says he goes to the washroom to pee so often--even during the night--that his sleep is always disturbed. He further states that, when he has to go pee, he has to go right away; it takes him a long time to finish peeing, but he feels that there’s still something there left. The funny part of the story is when he says that he’s “dripping”! He feels embarrassed when that happens and we would tease him “stinky”! He is strong and has never been sick in his life. What’s wrong with him, is this part of getting old? What should we do about this?
Your grandpa is most probably experiencing what many men in his age group are having. I am referring to a condition called Benign Prostatic Hypertrophy (BPH). Simply put, the prostate gland, which is located around the opening of the male urinary bladder, enlarges, causing it to obstruct the normal flow of urine, thus leading to the kind of symptoms your grandpa’s noticing. How it develops is not yet fully known, but it is thought that impaired hormonal factors are involved. This is commonly seen in men over age 50; it is usually a progressive disease where patients also notice their force/stream of urine is decreased and or interrupted. Hesitancy (experiencing difficulty starting the flow of urine) and urinary tract/bladder infections are not uncommon. I would recommend your grandpa visit his physician to be examined. There are various ways of treating this disorder, either by taking pills to shrink the prostate or improve the symptoms or by undergoing one of the surgical procedures to remove/scrape the prostate gland. For now, I ‘d suggest that your grandpa not drink too much fluid, particularly caffeine-containing beverages and alcohol, before going to bed to avoid getting the urge to urinate at night. There are also some drugs he should avoid, such as decongestants that can stimulate smooth muscle in the bladder neck and prostate, increasing the obstruction and others types that can affect bladder muscle contractility. There are some “alternative” drugs such as Saw Palmetto and African plum tree which are examples of plant extracts used by patients to reduce BPH symptoms, but identification of and how the active ingredients work and long-term efficacy and safety are often unclear in these mixtures.
P.S. Some patients ask me, about their concern of decreasing their “manliness” (eg. Problems achieving/maintaining erections) after prostate surgery, the answer, generally, is NO, although it could be a remote complication they should discuss in more detail with the urologist.
Dear Dr. Denise,
My husband has been having difficulty getting erections for the last several months, and our sex life is suffering. Is there something wrong with him, or is it me?? Help!
Erectile dysfunction (ED) is the persistent inability to achieve or maintain an erection sufficiently firm for satisfactory sexual activity. There are many underlying conditions that could present as ED, including reversible (eg., including certain medications, depression, prostatitis) and irreversible (eg., including high blood pressure, smoking, high cholesterol, neurologic disease, diabetes, pelvic surgery or trauma damaging the pelvic nerves related to erections) factors. If sleep-induced and self-stimulated erections are firmer than erections with the sexual partner, this could point to psychological factors such as personal issues he is struggling with (eg., insecurity, perfectionism) or interpersonal issues/difficulties within the relationship. Decreased sexual desire/fewer sexual thoughts and fantasies could be a sign of depression, decreased testosterone levels, increased prolactin hormone levels, medications, and psychodynamic issues (likely complex, such as a learned response not to feel emotions generally). Delayed ejaculation may suggest a medication effect or decreased testosterone. Early and painful ejaculation may be due to prostatitis. The effect of certain drugs, depression, and decreased testosterone levels may lead to decreased orgasm intensity. Whereas generalized and lifelong ED may be due to a congenital or past traumatic blood vessel damage, potentially amenable to microvascular surgery. It is important that you go, preferably as a couple, to see a doctor who would likely review a sexual and medical history and perform a physical examination and laboratory investigations to try to distinguish reversible from irreversible factors as well as look for risks associated with resumption of intercourse and orgasm (eg. Cardiac risk, respiratory or other physical compromise). Depending on the factors contributing to the ED, treatment ranges from psychotherapy/couple’s therapy, to Vacuum Erection Devices, and drugs that can be taken orally such as Viagra/Cialis and those that can be given by injection/urethral instillation. These various forms of treatment all have important contraindications that should be ruled out, so please make sure to have an open, frank discussion with your doctor first.
Remember: your health (not just physical/body, but also emotional, spiritual, and mental health) is foremost in your own hands; health starts at home. Take care, and mind your health! Meegwetch!
urban NDN - August 2008 - issue 3
My 62 year-old grandpa has been complaining of problems with urination. He says he goes to the washroom to pee so often--even during the night--that his sleep is always disturbed. He further states that, when he has to go pee, he has to go right away; it takes him a long time to finish peeing, but he feels that there’s still something there left. The funny part of the story is when he says that he’s “dripping”! He feels embarrassed when that happens and we would tease him “stinky”! He is strong and has never been sick in his life. What’s wrong with him, is this part of getting old? What should we do about this?
Your grandpa is most probably experiencing what many men in his age group are having. I am referring to a condition called Benign Prostatic Hypertrophy (BPH). Simply put, the prostate gland, which is located around the opening of the male urinary bladder, enlarges, causing it to obstruct the normal flow of urine, thus leading to the kind of symptoms your grandpa’s noticing. How it develops is not yet fully known, but it is thought that impaired hormonal factors are involved. This is commonly seen in men over age 50; it is usually a progressive disease where patients also notice their force/stream of urine is decreased and or interrupted. Hesitancy (experiencing difficulty starting the flow of urine) and urinary tract/bladder infections are not uncommon. I would recommend your grandpa visit his physician to be examined. There are various ways of treating this disorder, either by taking pills to shrink the prostate or improve the symptoms or by undergoing one of the surgical procedures to remove/scrape the prostate gland. For now, I ‘d suggest that your grandpa not drink too much fluid, particularly caffeine-containing beverages and alcohol, before going to bed to avoid getting the urge to urinate at night. There are also some drugs he should avoid, such as decongestants that can stimulate smooth muscle in the bladder neck and prostate, increasing the obstruction and others types that can affect bladder muscle contractility. There are some “alternative” drugs such as Saw Palmetto and African plum tree which are examples of plant extracts used by patients to reduce BPH symptoms, but identification of and how the active ingredients work and long-term efficacy and safety are often unclear in these mixtures.
P.S. Some patients ask me, about their concern of decreasing their “manliness” (eg. Problems achieving/maintaining erections) after prostate surgery, the answer, generally, is NO, although it could be a remote complication they should discuss in more detail with the urologist.
Dear Dr. Denise,
My husband has been having difficulty getting erections for the last several months, and our sex life is suffering. Is there something wrong with him, or is it me?? Help!
Erectile dysfunction (ED) is the persistent inability to achieve or maintain an erection sufficiently firm for satisfactory sexual activity. There are many underlying conditions that could present as ED, including reversible (eg., including certain medications, depression, prostatitis) and irreversible (eg., including high blood pressure, smoking, high cholesterol, neurologic disease, diabetes, pelvic surgery or trauma damaging the pelvic nerves related to erections) factors. If sleep-induced and self-stimulated erections are firmer than erections with the sexual partner, this could point to psychological factors such as personal issues he is struggling with (eg., insecurity, perfectionism) or interpersonal issues/difficulties within the relationship. Decreased sexual desire/fewer sexual thoughts and fantasies could be a sign of depression, decreased testosterone levels, increased prolactin hormone levels, medications, and psychodynamic issues (likely complex, such as a learned response not to feel emotions generally). Delayed ejaculation may suggest a medication effect or decreased testosterone. Early and painful ejaculation may be due to prostatitis. The effect of certain drugs, depression, and decreased testosterone levels may lead to decreased orgasm intensity. Whereas generalized and lifelong ED may be due to a congenital or past traumatic blood vessel damage, potentially amenable to microvascular surgery. It is important that you go, preferably as a couple, to see a doctor who would likely review a sexual and medical history and perform a physical examination and laboratory investigations to try to distinguish reversible from irreversible factors as well as look for risks associated with resumption of intercourse and orgasm (eg. Cardiac risk, respiratory or other physical compromise). Depending on the factors contributing to the ED, treatment ranges from psychotherapy/couple’s therapy, to Vacuum Erection Devices, and drugs that can be taken orally such as Viagra/Cialis and those that can be given by injection/urethral instillation. These various forms of treatment all have important contraindications that should be ruled out, so please make sure to have an open, frank discussion with your doctor first.
Remember: your health (not just physical/body, but also emotional, spiritual, and mental health) is foremost in your own hands; health starts at home. Take care, and mind your health! Meegwetch!
Diabetes Mellitus
FJ, Volume 22, Number 11
June 05-20, 2008
FJ, Volume 22, Number 15
August 05-20, 2008
Dear Dra. Denise,
My tatay has diabetes and his kuya also has diabetes. Does that mean I will get diabetes, or can I prevent it somehow?
Diabetes mellitus (DM) is a common long-term metabolic disturbance characterized by high fasting blood sugar. It is a syndrome caused by an absolute or relative lack of insulin, resistance to the action of insulin, or both. When severe, it affects the body’s breakdown of carbohydrates, fats, and proteins. Severe long-term DM may lead to complications involving small blood vessels, large blood vessels, and nerve damage, affecting multiple organs and systems.
The goals of therapy are to control the symptoms; to establish and maintain optimum metabolic control, while avoiding low blood sugars; to prevent or minimize the risk of complications; and to achieve optimal control of other associated illnesses like high blood pressure and high cholesterol
Therapy includes teaching the diabetic about diabetes, the role of diet, exercise and medications, how and when to self-monitor, management of sick days, recognition and treatment of low blood sugar, the major side effects of medications and how to adjust drugs in response to changes in diet and activity, and care of the feet. Individualized diet management counseled by a dietician should be done. Total calorie intake should be reduced to decrease weight and improve metabolic control. Self-monitoring of blood sugar levels is important. Physical activity and exercise improve heart function, enhance sensitivity to insulin, lower blood pressure and cholesterol levels, and improve sugar control. Medications should be adjusted with meals and exercise. Regular doctor check-ups should include blood pressure measurements; foot exams; blood tests of long-term control (usually every 3-6 months); checks of the glucose monitor; diet and diabetes management skills reinforcement; kidney function tests; fasting cholesterol tests (every 1-3 years if initially normal); and eye exams.
To screen for diabetes, a fasting blood glucose level should be measured every 3 years in those over age 40. Earlier and more frequent testing may need to be done in those with higher risk: first degree relative with DM, member of high-risk population (aboriginal, Hispanic, Asian or African descent), history of impaired sugar tolerance or impaired fasting sugar, presence of complications associated with DM, vascular disease, history of DM during pregnancy, high blood pressure, high cholesterol, overweight, abdominal obesity, and certain diseases. Since your tatay is a first-degree relative, you are at a higher risk and should have your blood tested.
Those with high blood sugars but below the diabetes threshold are considered to have prediabetes (includes both impaired fasting glucose and impaired glucose tolerance). Those with metabolic syndrome (obesity, high blood pressure, high cholesterol, insulin resistance, and sugar abnormalities) have a significant risk of DM and of heart and blood vessel disease.
Some studies have shown that progression to DM in high-risk individuals may be preventable: diet modification with restriction of calories and reduced fat intake combined with supervised, moderately intense physical activity of about 150 minutes a week can reduce the risk of DM by 58% at four years. The associated weight loss was about 5% of initial body weight. Some diabetes medications given to high-risk individuals have also shown to help delay/prevent the development of diabetes. There are no known safe and effective measures to prevent type I DM, which tends to affect those at a younger age.
It is great that you are looking after your health—an ounce of prevention is worth a pound of cure! Your health (not just physical/body, but also emotional, spiritual, and mental health) is foremost in your own hands; health starts at home. Alagaan ninyo ang katawan at kalusugan ninyo! Take care, and mind your health!
June 05-20, 2008
FJ, Volume 22, Number 15
August 05-20, 2008
Dear Dra. Denise,
My tatay has diabetes and his kuya also has diabetes. Does that mean I will get diabetes, or can I prevent it somehow?
Diabetes mellitus (DM) is a common long-term metabolic disturbance characterized by high fasting blood sugar. It is a syndrome caused by an absolute or relative lack of insulin, resistance to the action of insulin, or both. When severe, it affects the body’s breakdown of carbohydrates, fats, and proteins. Severe long-term DM may lead to complications involving small blood vessels, large blood vessels, and nerve damage, affecting multiple organs and systems.
The goals of therapy are to control the symptoms; to establish and maintain optimum metabolic control, while avoiding low blood sugars; to prevent or minimize the risk of complications; and to achieve optimal control of other associated illnesses like high blood pressure and high cholesterol
Therapy includes teaching the diabetic about diabetes, the role of diet, exercise and medications, how and when to self-monitor, management of sick days, recognition and treatment of low blood sugar, the major side effects of medications and how to adjust drugs in response to changes in diet and activity, and care of the feet. Individualized diet management counseled by a dietician should be done. Total calorie intake should be reduced to decrease weight and improve metabolic control. Self-monitoring of blood sugar levels is important. Physical activity and exercise improve heart function, enhance sensitivity to insulin, lower blood pressure and cholesterol levels, and improve sugar control. Medications should be adjusted with meals and exercise. Regular doctor check-ups should include blood pressure measurements; foot exams; blood tests of long-term control (usually every 3-6 months); checks of the glucose monitor; diet and diabetes management skills reinforcement; kidney function tests; fasting cholesterol tests (every 1-3 years if initially normal); and eye exams.
To screen for diabetes, a fasting blood glucose level should be measured every 3 years in those over age 40. Earlier and more frequent testing may need to be done in those with higher risk: first degree relative with DM, member of high-risk population (aboriginal, Hispanic, Asian or African descent), history of impaired sugar tolerance or impaired fasting sugar, presence of complications associated with DM, vascular disease, history of DM during pregnancy, high blood pressure, high cholesterol, overweight, abdominal obesity, and certain diseases. Since your tatay is a first-degree relative, you are at a higher risk and should have your blood tested.
Those with high blood sugars but below the diabetes threshold are considered to have prediabetes (includes both impaired fasting glucose and impaired glucose tolerance). Those with metabolic syndrome (obesity, high blood pressure, high cholesterol, insulin resistance, and sugar abnormalities) have a significant risk of DM and of heart and blood vessel disease.
Some studies have shown that progression to DM in high-risk individuals may be preventable: diet modification with restriction of calories and reduced fat intake combined with supervised, moderately intense physical activity of about 150 minutes a week can reduce the risk of DM by 58% at four years. The associated weight loss was about 5% of initial body weight. Some diabetes medications given to high-risk individuals have also shown to help delay/prevent the development of diabetes. There are no known safe and effective measures to prevent type I DM, which tends to affect those at a younger age.
It is great that you are looking after your health—an ounce of prevention is worth a pound of cure! Your health (not just physical/body, but also emotional, spiritual, and mental health) is foremost in your own hands; health starts at home. Alagaan ninyo ang katawan at kalusugan ninyo! Take care, and mind your health!
Wednesday, July 23, 2008
A Kookum Has an Embarrassing Question
Housecall with Dr. Denise
urban NDN -July 2008 - issue 2
This month I'm sharing more health questions I've come across and my responses. If you have any health-related questions, please feel free to contact me at the information below.
My Kookum has been complaining of leaking pee when she coughs, laughs, or sneezes. She is too embarrassed to see the doctor. Why is this happening, and what can she do?
Stress incontinence (the loss of urine due to an increase in pressure in the tummy) is more common in women. Weakness in the pelvis muscles (eg due to childbirth, abdominal obesity--overweight in the tummy) and thinning of the bladder and vaginal muscles and tissues from the decrease in estrogen after menopause are often contributing factors. Urge incontinence is leakage due to inability to delay peeing when an urge is felt. Causes include bladder wall hyperactivity and neurological disorders such as Parkinson’s Disease and stroke. Overflow incontinence involves leakage due to an over-distended bladder usually from blocked urine outlet (eg. enlarged prostate) or neurological causes (eg. multiple sclerosis, diabetes affecting the nerves). Functional incontinence is caused by the inability to get to a toilet such as due to physical constraints (eg restricted mobility), mental factors (eg. dementia, depression), and environmental barriers (eg. distance to toilet, positioning).
Her doctor should rule out problems like a urinary tract infection or a problem with the nerves controlling the bladder muscles. Some things she can do include: decreasing caffeine intake; addressing any bowel problems like constipation; limiting fluid intake—1.5-2 L/d is considered appropriate; losing weight; quitting smoking; watching high-impact physical activities; avoiding some types of medications (check with her doctor) like diuretics, some blood pressure and depression drugs, and alcohol; and improving mobility & accessibility to toilets. When secondary causes have been ruled out or treated, she can try pelvic floor muscle training (aka Kegels): do a minimum of 30-45 pelvic floor muscle contractions (goal of 10 seconds for each contraction); done in 2 or 3 sets; may take 6-8 weeks to see results. To contract the pelvic floor muscle, instruct her to pee, and while she’s peeing, she should squeeze her pelvic muscles to stop the flow of pee. Biofeedback and/or electrical stimulation therapy can teach her to isolate and control these muscles if she is not having any luck. If the problem is severe, her doc might refer her to a gynecologist/urologist who could confirm the diagnosis and possibly book her for surgery. Another option is wearing pads/ “Depends” to catch the leak. Depending on the cause, there are some medications her doctor can prescribe to help manage her symptoms. There are different treatments available for men who have difficulty with stress incontinence after having prostate surgery—check with their urologist.
I have a new sexual partner who told me to get checked for STD’s, even though I feel fine. What is involved in an STD screen, and when should someone get checked?
A common misperception is that no symptoms, means no STI (sexually-transmitted infections). This is far from the truth, and is a huge reason for the continued spread of STIs. Get tested when: you have unprotected (no condom) sex, you have a new partner, you are worried about it, you are experiencing any symptoms such as discharge, pelvic pain/burning, lumps, bumps, sores, unusual vaginal bleeding, or fertility concerns. Many people choose to get tested regularly, such as every 6 months, or with their annual physical exam. A typical screen can include blood tests for HIV (anonymous and requires your consent), Hepatitis B, Syphilis, and Herpes Simplex (although some docs don’t check for herpes because it is so common, and can’t be cured—however there are medications that can decrease the duration and intensity of recurrences as well as the likelihood of spreading the infection). Gonorrhea and Chlamydia can be checked in two ways: 1) a pee test or 2) a swab. For women, this is a swab of the inside of the cervix (opening of the uterus) requiring the insertion of a speculum typically used in Pap tests. For men, this requires a swab of the urethra/inside the penis. If you are uncomfortable with the swab tests, you can get the pee test instead, keeping in mind that these tests are not as sensitive as the swabs. It’s way better to get tested than not—for treatment and relief from easily treatable infections, management with improved outcome of the non-curable ones, prevention of spread, and peace of mind. Tests for Genital Warts are more specialized and seldom performed (extremely common and difficult to treat), but often a doctor can recognize them on examination. Tests for vaginal infections (not necessarily sexually-transmitted) such as yeast, trichomonas, and bacterial vaginosis are usually reserved for women with symptoms.
urban NDN -July 2008 - issue 2
This month I'm sharing more health questions I've come across and my responses. If you have any health-related questions, please feel free to contact me at the information below.
My Kookum has been complaining of leaking pee when she coughs, laughs, or sneezes. She is too embarrassed to see the doctor. Why is this happening, and what can she do?
Stress incontinence (the loss of urine due to an increase in pressure in the tummy) is more common in women. Weakness in the pelvis muscles (eg due to childbirth, abdominal obesity--overweight in the tummy) and thinning of the bladder and vaginal muscles and tissues from the decrease in estrogen after menopause are often contributing factors. Urge incontinence is leakage due to inability to delay peeing when an urge is felt. Causes include bladder wall hyperactivity and neurological disorders such as Parkinson’s Disease and stroke. Overflow incontinence involves leakage due to an over-distended bladder usually from blocked urine outlet (eg. enlarged prostate) or neurological causes (eg. multiple sclerosis, diabetes affecting the nerves). Functional incontinence is caused by the inability to get to a toilet such as due to physical constraints (eg restricted mobility), mental factors (eg. dementia, depression), and environmental barriers (eg. distance to toilet, positioning).
Her doctor should rule out problems like a urinary tract infection or a problem with the nerves controlling the bladder muscles. Some things she can do include: decreasing caffeine intake; addressing any bowel problems like constipation; limiting fluid intake—1.5-2 L/d is considered appropriate; losing weight; quitting smoking; watching high-impact physical activities; avoiding some types of medications (check with her doctor) like diuretics, some blood pressure and depression drugs, and alcohol; and improving mobility & accessibility to toilets. When secondary causes have been ruled out or treated, she can try pelvic floor muscle training (aka Kegels): do a minimum of 30-45 pelvic floor muscle contractions (goal of 10 seconds for each contraction); done in 2 or 3 sets; may take 6-8 weeks to see results. To contract the pelvic floor muscle, instruct her to pee, and while she’s peeing, she should squeeze her pelvic muscles to stop the flow of pee. Biofeedback and/or electrical stimulation therapy can teach her to isolate and control these muscles if she is not having any luck. If the problem is severe, her doc might refer her to a gynecologist/urologist who could confirm the diagnosis and possibly book her for surgery. Another option is wearing pads/ “Depends” to catch the leak. Depending on the cause, there are some medications her doctor can prescribe to help manage her symptoms. There are different treatments available for men who have difficulty with stress incontinence after having prostate surgery—check with their urologist.
I have a new sexual partner who told me to get checked for STD’s, even though I feel fine. What is involved in an STD screen, and when should someone get checked?
A common misperception is that no symptoms, means no STI (sexually-transmitted infections). This is far from the truth, and is a huge reason for the continued spread of STIs. Get tested when: you have unprotected (no condom) sex, you have a new partner, you are worried about it, you are experiencing any symptoms such as discharge, pelvic pain/burning, lumps, bumps, sores, unusual vaginal bleeding, or fertility concerns. Many people choose to get tested regularly, such as every 6 months, or with their annual physical exam. A typical screen can include blood tests for HIV (anonymous and requires your consent), Hepatitis B, Syphilis, and Herpes Simplex (although some docs don’t check for herpes because it is so common, and can’t be cured—however there are medications that can decrease the duration and intensity of recurrences as well as the likelihood of spreading the infection). Gonorrhea and Chlamydia can be checked in two ways: 1) a pee test or 2) a swab. For women, this is a swab of the inside of the cervix (opening of the uterus) requiring the insertion of a speculum typically used in Pap tests. For men, this requires a swab of the urethra/inside the penis. If you are uncomfortable with the swab tests, you can get the pee test instead, keeping in mind that these tests are not as sensitive as the swabs. It’s way better to get tested than not—for treatment and relief from easily treatable infections, management with improved outcome of the non-curable ones, prevention of spread, and peace of mind. Tests for Genital Warts are more specialized and seldom performed (extremely common and difficult to treat), but often a doctor can recognize them on examination. Tests for vaginal infections (not necessarily sexually-transmitted) such as yeast, trichomonas, and bacterial vaginosis are usually reserved for women with symptoms.
Monday, June 23, 2008
Loving in a Dangerous Time
Housecall with Dr. Denise
urban NDN - June 2008 - issue 1
Tansi! I’d like to share some health questions I’ve come across and my responses. If you have any health-related questions, please feel free to contact me at the information below.
I just learned that someone I fooled around with a few months ago is HIV-positive. What kinds of activities are risky? What should I do?
You can get HIV if the virus gets into your bloodstream from another person who is infected with HIV. It can enter your body through the infected person’s semen, vaginal fluid, or blood.
The Canadian HIV/AIDS Information Centre ranked activities as:
No risk: To our knowledge, none of the practices in this group has ever lead to HIV infection. There is no potential for transmission since none of the basic conditions for infection are present. This category includes fantasizing, h and holding, phone sex, mutual masturbation, bubblebaths, sensual touch and massage, cybersex, masturbation, hugging, watching erotic videos, dry kissing (no exchange of saliva), unshared use of sex toys, getting the person’s feces or urine on the body.
No real risk: The practices in this category present a potential for HIV transmission because they involved an exchange of body fluids (such as semen, vaginal fluid or blood). However, the possibility of HIV transmission appears to be unlikely. There are no confirmed reports of infection from these activities. This category includes wet kissing (saliva exchanged), receiving fellatio (blow job, getting head), receiving cunnilingus (eating out), giving anilingus (rimming, licking ass), giving or receiving digital/manual intercourse (anal or vaginal fingering or fisting), sharing sex toys with a new condom or disinfected and rinsed, getting the person’s feces or urine into the body.
Low risk: The practices in this category present a potential for HIV transmission. There are also a few reports of infection attributed to these activities: giving fellatio or cunnilingus, receiving anilingus (rim job), vaginal intercourse with a condom, and anal intercourse with a condom.
High risk: Practices in this category present a potential for HIV transmission and there are a significant number of scientific studies that associate these activities with HIV infection: shared sex toys, vaginal intercourse without a condom and anal intercourse without a condom. Any activities that involve drawing blood or break the skin, such as body piercing and tattooing, are high-risk activities that require sterile precautions, i.e., new needles, new ink, proper after care and sterilization every time. These precautions will probably not be available to a do-it-yourselfer or may not be adhered to by less reputable establishments. You should seek out professional technicians who adhere to proper sterilization and safety procedures.
Use of condoms with Nonoxynol 9 (a chemical that kills sperm and prevents pregnancy) is considered risky, because the harsh chemicals in it can damage the lining of the vagina or rectum and provide a transmission route for HIV.
There is a “window period” of three to six months between the time a person is infected with HIV and the time that they will test positive for HIV antibodies. It is during this window period that a person is most infectious and most likely to infect someone else, because they do not know they are infected.
Therefore you should:
Get tested for HIV and all other STIs, and get treated accordingly. Get tested periodically, because earlier detection leads to better outcomes.
Avoid sexual activities until at least 3 to 6 months after your HIV test.
To prevent the exchange of bodily fluids, avoid contact between bodily fluids and you or your partner(s) mouth, vagina, anus, penis, or an open cut or sore.
Practice safer sex.
Use a condom—it substantially reduces the risk of infection if you are giving or receiving. Remember, though, that condom use does not remove the risk of STIs—including HIV, genital warts, syphilis, herpes; condoms just decrease the risk substantially. Abstinence is the only surefire way to remove the risk.
Use a water-based lubricant—it increases your stimulation and decreases the risks.
Reduce the number of sexual partners.
Get the facts—talk to your doctor and keep informed about your health!
urban NDN - June 2008 - issue 1
Tansi! I’d like to share some health questions I’ve come across and my responses. If you have any health-related questions, please feel free to contact me at the information below.
I just learned that someone I fooled around with a few months ago is HIV-positive. What kinds of activities are risky? What should I do?
You can get HIV if the virus gets into your bloodstream from another person who is infected with HIV. It can enter your body through the infected person’s semen, vaginal fluid, or blood.
The Canadian HIV/AIDS Information Centre ranked activities as:
No risk: To our knowledge, none of the practices in this group has ever lead to HIV infection. There is no potential for transmission since none of the basic conditions for infection are present. This category includes fantasizing, h and holding, phone sex, mutual masturbation, bubblebaths, sensual touch and massage, cybersex, masturbation, hugging, watching erotic videos, dry kissing (no exchange of saliva), unshared use of sex toys, getting the person’s feces or urine on the body.
No real risk: The practices in this category present a potential for HIV transmission because they involved an exchange of body fluids (such as semen, vaginal fluid or blood). However, the possibility of HIV transmission appears to be unlikely. There are no confirmed reports of infection from these activities. This category includes wet kissing (saliva exchanged), receiving fellatio (blow job, getting head), receiving cunnilingus (eating out), giving anilingus (rimming, licking ass), giving or receiving digital/manual intercourse (anal or vaginal fingering or fisting), sharing sex toys with a new condom or disinfected and rinsed, getting the person’s feces or urine into the body.
Low risk: The practices in this category present a potential for HIV transmission. There are also a few reports of infection attributed to these activities: giving fellatio or cunnilingus, receiving anilingus (rim job), vaginal intercourse with a condom, and anal intercourse with a condom.
High risk: Practices in this category present a potential for HIV transmission and there are a significant number of scientific studies that associate these activities with HIV infection: shared sex toys, vaginal intercourse without a condom and anal intercourse without a condom. Any activities that involve drawing blood or break the skin, such as body piercing and tattooing, are high-risk activities that require sterile precautions, i.e., new needles, new ink, proper after care and sterilization every time. These precautions will probably not be available to a do-it-yourselfer or may not be adhered to by less reputable establishments. You should seek out professional technicians who adhere to proper sterilization and safety procedures.
Use of condoms with Nonoxynol 9 (a chemical that kills sperm and prevents pregnancy) is considered risky, because the harsh chemicals in it can damage the lining of the vagina or rectum and provide a transmission route for HIV.
There is a “window period” of three to six months between the time a person is infected with HIV and the time that they will test positive for HIV antibodies. It is during this window period that a person is most infectious and most likely to infect someone else, because they do not know they are infected.
Therefore you should:
Get tested for HIV and all other STIs, and get treated accordingly. Get tested periodically, because earlier detection leads to better outcomes.
Avoid sexual activities until at least 3 to 6 months after your HIV test.
To prevent the exchange of bodily fluids, avoid contact between bodily fluids and you or your partner(s) mouth, vagina, anus, penis, or an open cut or sore.
Practice safer sex.
Use a condom—it substantially reduces the risk of infection if you are giving or receiving. Remember, though, that condom use does not remove the risk of STIs—including HIV, genital warts, syphilis, herpes; condoms just decrease the risk substantially. Abstinence is the only surefire way to remove the risk.
Use a water-based lubricant—it increases your stimulation and decreases the risks.
Reduce the number of sexual partners.
Get the facts—talk to your doctor and keep informed about your health!
Wednesday, April 23, 2008
Grief
FJ, Volume 22, Number 6
March 20-April 05, 2008
As anyone who is holding this paper knows, my editor is dead. Not only is my editor gone, but also my tita. And not only my tita, but also my mentor. And to top it all off, I’ve also lost my good friend and the catalyst to my connection to the Winnipeg I now call home, and my connection to the Manitoba Filipino community I now call my people. This really sucks.
I know I’m an adult, but I can’t help feeling downright selfish about the whole situation. Sure, I am terribly sad about what her family and the community have lost—shed tears at the thought--but, when it comes right down to it, I’m most sad about her not being there for me. It’s not that I had contact with her on a daily basis or the honour of being in her inner circle as true family does, but to me, just the knowledge that someone so pure and brilliant, so self-sacrificing and so passionate about our people, so supportive and empowering to me--existed was enough to keep me going. She is probably one of the closest people I’ve known to embodying what I consider a martyr. And now that light is gone.
Of course the light isn’t truly gone, right? I mean, I know the memory and love continues, her vision won’t die, and her legacy will be kept alive, but, really, I have to admit, it’s always better to have that inspiration in the flesh, the gentle persistent reminder phone call from that soft voice about the FJ deadline or the PCCM meeting, the twinkle of recognition in her eyes in a crowd of new faces, the calm knowing smile, the paradoxical sight of her--both fragile and purposeful strength, this beautiful spirit caught in the very real, physical pain of this world.
Being a doctor, I can’t help but focus on this pain. How frustrated I was at her insistence to be strong, when I warned her to take a break, not let the stresses get to her. She always said she was fine, but I knew. It is hard knowing this and caring so much, but not being able to change a thing. It is hard trying to get others to “lay off” and try not to involve her in the petty stresses of everyday life—so she could really heal. It is hard trying to convince someone whose strength of convictions overpower seemingly anything—be it medical knowledge or worried warnings from someone who couldn’t stand the thought of the possibly preventable demise of a loved one. I think we all have contributed to this—it is natural when being around someone so strong to rely on her, to not see that she needs rest, to expect nothing but strength from her, even to push her beyond limits she is not even consciously aware of. This is raw sadness and regret and frustration and love.
I guess if there’s one thing, one message I want to say out of this terrible experience—it is this:
Be selfish. Take a break. Sharpen the saw. Love yourself, and that means all aspects of you—body, heart, mind, soul. If you are feeding your soul with your body, that is not balance, not healthy, and that eventually robs the very people you are serving of the pleasure of being around a healthier you for greater longevity. By all means be passionate and serve the community! But serving the community in a healthful manner means serving yourself too, and giving the gift of contribution to others—let others carry the burden too. Live with integrity. By this I don’t mean simple honesty, but be integrated—balanced. Nurture all the aspects of your being. Take a “mental health” moment. Don’t spread yourself too thin. Listen to what your body is telling you. Strive for feeling, thinking, saying, and acting from an integrated core. Live your truth, not the perception of the truth of others, be they loved ones or a community. Learn to rely on others occasionally. Be okay with sometimes being weak or vulnerable. Love yourself just as much as you love others. Realize that you need this self-love to truly give to others. Openly appreciate the time you have been given, and everything in this world that has been given to you to work with. Above all, let the memory of a fiery leader inspire you to give back to your world from a place of true health.
March 20-April 05, 2008
As anyone who is holding this paper knows, my editor is dead. Not only is my editor gone, but also my tita. And not only my tita, but also my mentor. And to top it all off, I’ve also lost my good friend and the catalyst to my connection to the Winnipeg I now call home, and my connection to the Manitoba Filipino community I now call my people. This really sucks.
I know I’m an adult, but I can’t help feeling downright selfish about the whole situation. Sure, I am terribly sad about what her family and the community have lost—shed tears at the thought--but, when it comes right down to it, I’m most sad about her not being there for me. It’s not that I had contact with her on a daily basis or the honour of being in her inner circle as true family does, but to me, just the knowledge that someone so pure and brilliant, so self-sacrificing and so passionate about our people, so supportive and empowering to me--existed was enough to keep me going. She is probably one of the closest people I’ve known to embodying what I consider a martyr. And now that light is gone.
Of course the light isn’t truly gone, right? I mean, I know the memory and love continues, her vision won’t die, and her legacy will be kept alive, but, really, I have to admit, it’s always better to have that inspiration in the flesh, the gentle persistent reminder phone call from that soft voice about the FJ deadline or the PCCM meeting, the twinkle of recognition in her eyes in a crowd of new faces, the calm knowing smile, the paradoxical sight of her--both fragile and purposeful strength, this beautiful spirit caught in the very real, physical pain of this world.
Being a doctor, I can’t help but focus on this pain. How frustrated I was at her insistence to be strong, when I warned her to take a break, not let the stresses get to her. She always said she was fine, but I knew. It is hard knowing this and caring so much, but not being able to change a thing. It is hard trying to get others to “lay off” and try not to involve her in the petty stresses of everyday life—so she could really heal. It is hard trying to convince someone whose strength of convictions overpower seemingly anything—be it medical knowledge or worried warnings from someone who couldn’t stand the thought of the possibly preventable demise of a loved one. I think we all have contributed to this—it is natural when being around someone so strong to rely on her, to not see that she needs rest, to expect nothing but strength from her, even to push her beyond limits she is not even consciously aware of. This is raw sadness and regret and frustration and love.
I guess if there’s one thing, one message I want to say out of this terrible experience—it is this:
Be selfish. Take a break. Sharpen the saw. Love yourself, and that means all aspects of you—body, heart, mind, soul. If you are feeding your soul with your body, that is not balance, not healthy, and that eventually robs the very people you are serving of the pleasure of being around a healthier you for greater longevity. By all means be passionate and serve the community! But serving the community in a healthful manner means serving yourself too, and giving the gift of contribution to others—let others carry the burden too. Live with integrity. By this I don’t mean simple honesty, but be integrated—balanced. Nurture all the aspects of your being. Take a “mental health” moment. Don’t spread yourself too thin. Listen to what your body is telling you. Strive for feeling, thinking, saying, and acting from an integrated core. Live your truth, not the perception of the truth of others, be they loved ones or a community. Learn to rely on others occasionally. Be okay with sometimes being weak or vulnerable. Love yourself just as much as you love others. Realize that you need this self-love to truly give to others. Openly appreciate the time you have been given, and everything in this world that has been given to you to work with. Above all, let the memory of a fiery leader inspire you to give back to your world from a place of true health.
Saturday, March 01, 2008
Male Genito-Urinary Problems
FJ, Volume 22, Number 4
February 20-March 05, 2008
Magandang araw mga kababayan! I received the following question, and thought it would be a good idea to get the input from one of my local kompadres, Ferdinand Galvan, who received his registered nursing training from UST College of Nursing and medical/general surgery training at DLSU in the Philippines (and practicing as a physician) before coming to Canada. At present, he is working at the Health Sciences Centre as an RN. Salamat po, Ferdie!
Dear Dr. Denise,
My 62 year-old Lolo Totoy has been complaining of problems with urination. He says he goes to the washroom to pee so often--even during the night--that his sleep is always disturbed. He further states that, when he has to go pee, he has to go right away; it takes him a long time to finish peeing, but he feels that there’s still something there left. The funny part of the story is when he says that he’s “dripping”! He feels embarrassed when that happens and we would tease him “stinky”! He is strong and has never been sick in his life. What’s wrong with him, is this part of getting old? What should we do about this?
Jun-Jun
Dear Jun-Jun,
Your Lolo Totoy is most probably experiencing what many men in his age group are having. I am referring to a condition called Benign Prostatic Hypertrophy (BPH). Simply put, the prostate gland, which is located around the opening of the male urinary bladder, enlarges, causing it to obstruct the normal flow of urine, thus leading to the kind of symptoms your lolo’s noticing. How it develops is not yet fully known, but it is thought that impaired hormonal factors are involved. This is commonly seen in men over age 50; it is usually a progressive disease where patients also notice their force/stream of urine is decreased and or interrupted. Hesitancy (experiencing difficulty starting the flow of urine) and urinary tract/bladder infections are not uncommon. I would recommend your lolo visit his physician and have himself examined. There are various ways of treating this disorder, either by taking pills to shrink the prostate or improve the symptoms or by undergoing one of the surgical procedures to remove/scrape the prostate gland. For now, I ‘d suggest that your lolo not drink too much fluid, particularly caffeine-containing beverages and alcohol, before going to bed to avoid getting the urge to urinate at night. There are also some drugs he should avoid, such as decongestants that can stimulate smooth muscle in the bladder neck and prostate, increasing the obstruction and others types that can affect bladder muscle contractility. There are some “alternative” drugs such as Saw Palmetto and African plum tree which are examples of plant extracts used by patients to reduce BPH symptoms, but identification of and how the active ingredients work and long-term efficacy and safety are often unclear in these mixtures.
P.S. Some patients ask me, about their concern of decreasing their “manliness” (eg. Problems achieving/maintaining erections) after prostate surgery, the answer, generally, is NO, although it could be a remote complication they should discuss in more detail with the urologist.
Dear Dr. Denise,
My husband has been having difficulty getting erections for the last several months, and our sex life is suffering. Is there something wrong with him, or is it me?? Help!
Erectile dysfunction (ED) is the persistent inability to achieve or maintain an erection sufficiently firm for satisfactory sexual activity. There are many underlying conditions that could present as ED, including reversible (eg., including certain medications, depression, prostatitis) and irreversible (eg., including high blood pressure, smoking, high cholesterol, neurologic disease, diabetes, pelvic surgery or trauma damaging the pelvic nerves related to erections) factors. If sleep-induced and self-stimulated erections are firmer than erections with the sexual partner, this could point to psychological factors such as personal issues he is struggling with (eg., insecurity, perfectionism) or interpersonal issues/difficulties within the relationship. Decreased sexual desire/fewer sexual thoughts and fantasies could be a sign of depression, decreased testosterone levels, increased prolactin hormone levels, medications, and psychodynamic issues (likely complex, such as a learned response not to feel emotions generally). Delayed ejaculation may suggest a medication effect or decreased testosterone. Early and painful ejaculation may be due to prostatitis. The effect of certain drugs, depression, and decreased testosterone levels may lead to decreased orgasm intensity. Whereas generalized and lifelong ED may be due to a congenital or past traumatic blood vessel damage, potentially amenable to microvascular surgery. It is important that you go, preferably as a couple, to see a doctor who would likely review a sexual and medical history and perform a physical examination and laboratory investigations to try to distinguish reversible from irreversible factors as well as look for risks associated with resumption of intercourse and orgasm (eg. Cardiac risk, respiratory or other physical compromise). Depending on the factors contributing to the ED, treatment ranges from psychotherapy/couple’s therapy, to Vacuum Erection Devices, and drugs that can be taken orally such as Viagra/Cialis and those that can be given by injection/urethral instillation. These various forms of treatment all have important contraindications that should be ruled out, so please make sure to have an open, frank discussion with your doctor first.
Remember, Pinoys and Pinays--your health (not just physical/body, but also emotional, spiritual, and mental health) is foremost in your own hands; health starts at home. Alagaan ninyo ang katawan at kalusugan ninyo! Take care, and mind your health!
February 20-March 05, 2008
Magandang araw mga kababayan! I received the following question, and thought it would be a good idea to get the input from one of my local kompadres, Ferdinand Galvan, who received his registered nursing training from UST College of Nursing and medical/general surgery training at DLSU in the Philippines (and practicing as a physician) before coming to Canada. At present, he is working at the Health Sciences Centre as an RN. Salamat po, Ferdie!
Dear Dr. Denise,
My 62 year-old Lolo Totoy has been complaining of problems with urination. He says he goes to the washroom to pee so often--even during the night--that his sleep is always disturbed. He further states that, when he has to go pee, he has to go right away; it takes him a long time to finish peeing, but he feels that there’s still something there left. The funny part of the story is when he says that he’s “dripping”! He feels embarrassed when that happens and we would tease him “stinky”! He is strong and has never been sick in his life. What’s wrong with him, is this part of getting old? What should we do about this?
Jun-Jun
Dear Jun-Jun,
Your Lolo Totoy is most probably experiencing what many men in his age group are having. I am referring to a condition called Benign Prostatic Hypertrophy (BPH). Simply put, the prostate gland, which is located around the opening of the male urinary bladder, enlarges, causing it to obstruct the normal flow of urine, thus leading to the kind of symptoms your lolo’s noticing. How it develops is not yet fully known, but it is thought that impaired hormonal factors are involved. This is commonly seen in men over age 50; it is usually a progressive disease where patients also notice their force/stream of urine is decreased and or interrupted. Hesitancy (experiencing difficulty starting the flow of urine) and urinary tract/bladder infections are not uncommon. I would recommend your lolo visit his physician and have himself examined. There are various ways of treating this disorder, either by taking pills to shrink the prostate or improve the symptoms or by undergoing one of the surgical procedures to remove/scrape the prostate gland. For now, I ‘d suggest that your lolo not drink too much fluid, particularly caffeine-containing beverages and alcohol, before going to bed to avoid getting the urge to urinate at night. There are also some drugs he should avoid, such as decongestants that can stimulate smooth muscle in the bladder neck and prostate, increasing the obstruction and others types that can affect bladder muscle contractility. There are some “alternative” drugs such as Saw Palmetto and African plum tree which are examples of plant extracts used by patients to reduce BPH symptoms, but identification of and how the active ingredients work and long-term efficacy and safety are often unclear in these mixtures.
P.S. Some patients ask me, about their concern of decreasing their “manliness” (eg. Problems achieving/maintaining erections) after prostate surgery, the answer, generally, is NO, although it could be a remote complication they should discuss in more detail with the urologist.
Dear Dr. Denise,
My husband has been having difficulty getting erections for the last several months, and our sex life is suffering. Is there something wrong with him, or is it me?? Help!
Erectile dysfunction (ED) is the persistent inability to achieve or maintain an erection sufficiently firm for satisfactory sexual activity. There are many underlying conditions that could present as ED, including reversible (eg., including certain medications, depression, prostatitis) and irreversible (eg., including high blood pressure, smoking, high cholesterol, neurologic disease, diabetes, pelvic surgery or trauma damaging the pelvic nerves related to erections) factors. If sleep-induced and self-stimulated erections are firmer than erections with the sexual partner, this could point to psychological factors such as personal issues he is struggling with (eg., insecurity, perfectionism) or interpersonal issues/difficulties within the relationship. Decreased sexual desire/fewer sexual thoughts and fantasies could be a sign of depression, decreased testosterone levels, increased prolactin hormone levels, medications, and psychodynamic issues (likely complex, such as a learned response not to feel emotions generally). Delayed ejaculation may suggest a medication effect or decreased testosterone. Early and painful ejaculation may be due to prostatitis. The effect of certain drugs, depression, and decreased testosterone levels may lead to decreased orgasm intensity. Whereas generalized and lifelong ED may be due to a congenital or past traumatic blood vessel damage, potentially amenable to microvascular surgery. It is important that you go, preferably as a couple, to see a doctor who would likely review a sexual and medical history and perform a physical examination and laboratory investigations to try to distinguish reversible from irreversible factors as well as look for risks associated with resumption of intercourse and orgasm (eg. Cardiac risk, respiratory or other physical compromise). Depending on the factors contributing to the ED, treatment ranges from psychotherapy/couple’s therapy, to Vacuum Erection Devices, and drugs that can be taken orally such as Viagra/Cialis and those that can be given by injection/urethral instillation. These various forms of treatment all have important contraindications that should be ruled out, so please make sure to have an open, frank discussion with your doctor first.
Remember, Pinoys and Pinays--your health (not just physical/body, but also emotional, spiritual, and mental health) is foremost in your own hands; health starts at home. Alagaan ninyo ang katawan at kalusugan ninyo! Take care, and mind your health!
Saturday, February 23, 2008
Journey to the Philippines Part 4: Meeting with the Presidents—Past and Current
FJ Volume 22, Number 3
Feb 05-20, 2008
I have so many wonderful memories of my trip to the Philippines July to August, 2007 that I’ve written about: attending the Ambassadors’, Consul Generals’, and Tourism Directors’ Tour (ACGTDT), a visit to the Senate and Philippine National Red Cross with Senator Dick Gordon, important interviews and continuing work on my Field Practicum for my Master’s in Public Health exploring the migration of Filipino doctors and health care workers to Canada. This column reviews my meetings with the Presidents—Gloria Macapagal-Arroyo and Fidel V. Ramos.
With the help and coordination of Senator Gordon, I was able to attend the July 28th inauguration of the Pacific Pearl Airways at Subic International Airport where President Macapagal-Arroyo and many other politicians and Pinoy bigwigs were going to be. The evening before, I hitched a ride to Subic with the dynamic Congresswoman Carissa Coscoluella where I got to ask her about her personal experience with Philippine politics while she treated me to a Jollibee Double Yum/Cheesy Cheese Fries combo on the drive up. The following morning I went to the Airport for the inauguration where I joked and shared a sumptuous lunch with the distinguished and charming members of the police force seated at my table. After President GMA entered, several presentations ensued. Following the festivities were some foto ops at the front, and I was lucky to get swept up in the crowd to get a photo with her. Amidst the crowd, I met briefly with GMA where I delivered a very short speech I prepared in Tagalog, thanks to the help of my table-mates and the servers. She was extremely gracious and quite warm, holding my hand and giving me a big hug. I then got a tour of Subic, including a look at the bankers where war supplies and ammo were kept, feeding the fish at Camayan Beach, an exhilarating Slide For Life in the jungle, checking out the macaque monkeys and bats, and topped off with a gorgeous Parasailing experience. I treated my guides to a delicious Pilipino meal at CocoLime’s before the drive home. What an awesome jam-packed day!
After my chance meeting with the gregarious former President Fidel Ramos at the PNRC, I gathered enough bravado to request an interview/meeting with him. I got the call that I would be meeting him August 6, 2007, 4 pm at his office at the 26th Floor, Ramos Peace and Dev’t Foundn (RPDEV). When he met with me, there was a bluster of activity while he spent a lot of his precious time setting me up with photographs, copies of his and others’ writing, and some keepsakes which he very graciously autographed for me, including a couple of books, one of his famous cigars, and a golfball! He reviewed the motto of his Foundation--a nonpartisan, non-profit, non-stock organization dedicated to achieving lasting piece, sustainable development, democratic governance and promoting socio-economic diplomacy in the Philippines and in the larger Asia-Pacific region: “Responsible citizenship is caring for others sharing what the Almighty has given each of us, and daring to make a positive difference in others’ lives. It is this quality of caring, sharing and daring for each other that the defining quality of what is called ‘civic responsibility.’” I learned of many of his initiatives and projects he is working on, including advocating for reforms to address the water crisis in Asia. He gave me a tour of the RPDEV rooms—first off was the Mt. Everest Room where he showed me his proud display of the three young Filipinas he supported who were the first to climb Mt. Everest. He taught me a lot of the history of the Philippines and about the important aspects of leadership, including the basics of leading a country. We discussed the problems of poverty and politics, including a comparison of the current administration with that of 10 years ago. He spoke of the war on terrorism and the importance of respecting religious differences. President Ramos was extremely funny, cracking jokes about golf and turning 100 years old to Department of Environment and Natural Resources Chairman, Cirio Santiago and me over a glass of wine. We discussed medical tourism and setting up health care facilities in areas of need as well as development of land. He showed me many of his photographs and shared anecdotes with me, and ended my meeting with a motivational greeting to the Filipino community in Canada, “The Philippines is a great country and so is Canada. But Filipinos …(-)Canadians or Canadians who used to be Filipinos should be sure to visit the motherland, which is the Philippines, because here we are caring sharing, and daring…We earned our independence just like Canada, the hard way. And they’re still fighting as a people to keep it pure, to keep it according to universal standards, and so, we need the help of everyone, including those out there, especially the Filipino-Canadians….the Philippines and Canada have an enduring partnership to promote a better world for everyone. This is what we call the Ramos Development Foundation. Our caring sharing and daring for each other and for everyone else. Thank you. Mabuhay. Kaiwana ito. We can do it.”
I was so honoured to take in such positive energy from GMA and “Steady Eddie” and to come home with so many gifts and memories from them. Maraming salamat po, Presidents past and present for the tremendous experience! Alagaan ninyo ang katawan at kalusugan ninyo! Until next time, take care, and mind your health!
Feb 05-20, 2008
I have so many wonderful memories of my trip to the Philippines July to August, 2007 that I’ve written about: attending the Ambassadors’, Consul Generals’, and Tourism Directors’ Tour (ACGTDT), a visit to the Senate and Philippine National Red Cross with Senator Dick Gordon, important interviews and continuing work on my Field Practicum for my Master’s in Public Health exploring the migration of Filipino doctors and health care workers to Canada. This column reviews my meetings with the Presidents—Gloria Macapagal-Arroyo and Fidel V. Ramos.
With the help and coordination of Senator Gordon, I was able to attend the July 28th inauguration of the Pacific Pearl Airways at Subic International Airport where President Macapagal-Arroyo and many other politicians and Pinoy bigwigs were going to be. The evening before, I hitched a ride to Subic with the dynamic Congresswoman Carissa Coscoluella where I got to ask her about her personal experience with Philippine politics while she treated me to a Jollibee Double Yum/Cheesy Cheese Fries combo on the drive up. The following morning I went to the Airport for the inauguration where I joked and shared a sumptuous lunch with the distinguished and charming members of the police force seated at my table. After President GMA entered, several presentations ensued. Following the festivities were some foto ops at the front, and I was lucky to get swept up in the crowd to get a photo with her. Amidst the crowd, I met briefly with GMA where I delivered a very short speech I prepared in Tagalog, thanks to the help of my table-mates and the servers. She was extremely gracious and quite warm, holding my hand and giving me a big hug. I then got a tour of Subic, including a look at the bankers where war supplies and ammo were kept, feeding the fish at Camayan Beach, an exhilarating Slide For Life in the jungle, checking out the macaque monkeys and bats, and topped off with a gorgeous Parasailing experience. I treated my guides to a delicious Pilipino meal at CocoLime’s before the drive home. What an awesome jam-packed day!
After my chance meeting with the gregarious former President Fidel Ramos at the PNRC, I gathered enough bravado to request an interview/meeting with him. I got the call that I would be meeting him August 6, 2007, 4 pm at his office at the 26th Floor, Ramos Peace and Dev’t Foundn (RPDEV). When he met with me, there was a bluster of activity while he spent a lot of his precious time setting me up with photographs, copies of his and others’ writing, and some keepsakes which he very graciously autographed for me, including a couple of books, one of his famous cigars, and a golfball! He reviewed the motto of his Foundation--a nonpartisan, non-profit, non-stock organization dedicated to achieving lasting piece, sustainable development, democratic governance and promoting socio-economic diplomacy in the Philippines and in the larger Asia-Pacific region: “Responsible citizenship is caring for others sharing what the Almighty has given each of us, and daring to make a positive difference in others’ lives. It is this quality of caring, sharing and daring for each other that the defining quality of what is called ‘civic responsibility.’” I learned of many of his initiatives and projects he is working on, including advocating for reforms to address the water crisis in Asia. He gave me a tour of the RPDEV rooms—first off was the Mt. Everest Room where he showed me his proud display of the three young Filipinas he supported who were the first to climb Mt. Everest. He taught me a lot of the history of the Philippines and about the important aspects of leadership, including the basics of leading a country. We discussed the problems of poverty and politics, including a comparison of the current administration with that of 10 years ago. He spoke of the war on terrorism and the importance of respecting religious differences. President Ramos was extremely funny, cracking jokes about golf and turning 100 years old to Department of Environment and Natural Resources Chairman, Cirio Santiago and me over a glass of wine. We discussed medical tourism and setting up health care facilities in areas of need as well as development of land. He showed me many of his photographs and shared anecdotes with me, and ended my meeting with a motivational greeting to the Filipino community in Canada, “The Philippines is a great country and so is Canada. But Filipinos …(-)Canadians or Canadians who used to be Filipinos should be sure to visit the motherland, which is the Philippines, because here we are caring sharing, and daring…We earned our independence just like Canada, the hard way. And they’re still fighting as a people to keep it pure, to keep it according to universal standards, and so, we need the help of everyone, including those out there, especially the Filipino-Canadians….the Philippines and Canada have an enduring partnership to promote a better world for everyone. This is what we call the Ramos Development Foundation. Our caring sharing and daring for each other and for everyone else. Thank you. Mabuhay. Kaiwana ito. We can do it.”
I was so honoured to take in such positive energy from GMA and “Steady Eddie” and to come home with so many gifts and memories from them. Maraming salamat po, Presidents past and present for the tremendous experience! Alagaan ninyo ang katawan at kalusugan ninyo! Until next time, take care, and mind your health!
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