Does Cold Weather Make Your Joints Stiff?

The heavy rain yesterday did not stop me from making a quick trip to the supermarket. Vehicles were slowing down due to the heavy downpour. I feel lucky I live 10-minutes away from the supermarket. I rushed to fill my basket of fresh produce so I can get back to work within an hour. On the way home, I frolicked, splashed and even let my hair catch some spray.

I just realized that I'm getting fond of the rain. Before, rain used to spoil my mood. It reminded me of sad and lonely moments.

I ♥ summer before the climate started changing. Summer meant trips to the beach and Sundays at the park. This year, however, summer had been unbearable. Since it was almost impossible for me to tow 2 hyperactive boys to the mall, we tried so many ways to beat the heat while keeping the electric bill under control.

Now, the rainy season has extended to the cool 'ber months. And my joints are killing me. Does weather influence joint pain? It's definitely not old age! I just found that there is no study that relates cold weather with joint pain. Historically, though, there was a research that show patients suffer increased joint pain and stiffness as barometric pressure drops. However, medical professionals do not find it conclusive due to lack of further research. If cold weather does not make my joints stiff, what does?

I asked mom and she feels the same because of increased uric acid. Hmmm. I found Dr. Steven Chang's article from Daily Dose helpful. Dr Chang shares findings of a study showing that women had 74% higher risk of getting gout from daily consumption of drinks with high fructose. Frusctose is commonly used in sweetened beverages because it is cheap and easy to dissolve. Patients with gout who experience re-occurring joint pain can have gouty arthritis. Worse, it can lead to chronic arthritis. So I better stay away from bottled and canned beverages with high fructose to keep my uric acid level down.

However, the study also noted that women who drank orange juice daily had 41% higher risk of gout than women who drank less. So I guess, going natural isn't always safe. Too much of anything can be harmful. High levels of uric acid may also be due to diabetes, side effect of cancer therapy, Nephrolithiasis or Kidney Stones among others.

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Celebrating Thank You Day

Filipinos are very fortunate for accessible, affordable and quality medical care at Veterans Memorial Medical Center (VMMC). VMMC is primarily a government hospital dedicated to our veterans. Fortunately, they have opened their facilities and services to the public (with proper authorization and consent from the Director). You can expect hospital policies to be strict but you can be assured that you will be taken care of. So far, I think it is the cleanest government hospital in Manila. In celebration of Thank You Day, I would like to throw in this post to the dedicated pediatricians at VMMC.

Vetereans Memorial Medical Center

The years 2005 and 2009 were critical for me. The first, being my first pregnancy, where the pediatricians detected a murmur in my first son’s heart. By early diagnosis, we were able to get him the medical attention and special care he needed. During the latter, my youngest was confined in his 2^nd week of life. I felt like I was a first-time mom again, but I was guided with patience by the resident pediatricians.

my little angels

I am greatful for the pediatricians at the VMMC (2005-2010) for taking care of my sons since birth. I would like to take this moment to especially thank Dr Jocelyn Cruz and Dr Jeanna Ples for being supportive, helpful and patient (with me) during Hosei's critical first year. And to Dr Maria Rosa Villaflor for supervising Tomas’ early days at the hospital.

View my entry (photo and message) and post yours!

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My First Year as a First-Time Mom

Tough Decisions for My Future Race Car Driver

My interest in medical facilities and equipment started in 2005. Hospitals seemed to be our favorite place to visit from June 2005 to August 2006. June to October was dedicated to visits to my father. Perhaps, I will be able to share that later. Like most, we would not pursue certain topics until someone in the family is affected. And the initial reaction is usually a denial.

In November of that year, I gave birth to my first son. Being my first, I couldn’t wait to see him and have him close to me. However, I was told that, like all newborns, he had to stay in the nursery for a minimum number of hours (I already forgot how long). The doctors make routine checks on vital signs to make sure that the newcomer can survive on is own.

I began to worry on the second day. He was still not allowed to leave the nursery. I was, of course, adamant and anxious to speak with his doctor. Later, I was told that the doctors were ready and will see me at the nursery.

The head resident pediatrician spoke first, explaining their initial observations in my son’s first 48 hours. First, my son had jaundice, which was probably due to incompatibilities in our blood type. I have seen newborns before and they have flushed skin. He was turning a bit yellowish, but was hard to see because of his skin color. So he had to undergo phototherapy and stay in the nursery for a few more days. I said to myself, I can live with that so long as he doesn’t get brain damage.

Then she went on to the sinker. Within my son’s 24 hours, they noticed a slight murmur in his heart. Obviously looking clueless, they asked me to listen using a stethoscope. His heartbeat had a faint rhythm, sort of calming to my ears. I hardly knew how a murmur would sound so I returned the steth. They went on and I knew they tried to simplify it. But it just wasn’t getting in my head. All I got was: my son has a heart condition and that he needs to have some tests as soon as he is done with the phototherapy.

2D Echocardiography @ Philippine Heart Center

For 3 days, I visited and fed him at the nursery. He had to stay in the basinet under 6 big fluorescent lamps. His eyes were covered to keep the bright light from blinding him. He was temporarily removed to have an x-ray, which revealed a dislocated fracture in his right clavicle. I was reassured by the doctors that infants heal fast. They made him a soft brace from cloth to correct the displaced fracture and facilitate healing and growth in its proper position. On his 4^th day, we were escorted to Dra Jeanna Ples’ clinic behind the Philippine Heart Center. He had his first 2D Echocardiography screening.

2D Echo and ECG Results

The 2D Echo report revealed interatrial communication with bi-directional shunting, a small Ventricular Septal Defect, Patent Ductus Arteriosus, Pressure gradient across the pulmonary artery = 9mmHg. We were told we had to monitor the pressure across the descending aorta and pulmonary venous drainage. Yes, more medical jargon that I will try to decode later, I thought.

And so, followed our regular visits to Dra Ples. At first, he was checked twice a month. Then, gradually, visits were reduced to once a month until such time that Dra Ples noted a couple of small holes in his heart and a thymic mass in his chest. We were referred to another pediatric cardiologist at the Philippine Heart Center. There, he had his first ECG, blood chemistry, serology (tumor marker) and CT Scan, in addition to his occasional 2D Echo screening. Another X-ray showed that his fracture was healing fast.

X-Ray and CT Scan Results

In June 2006, the CT Scan revealed a “possibility of a thymic mass. Seminoma may also be possible. Pleuro-parenchymal fibrosis, right upper lobe.” The physicians at the Philippine Heart Center recommended an open thoracotomy and mediastinal mass excision.

Being a first-time mom, I could not help but blame myself. I’ve read a lot about pregnancy, preparing for my first baby, asked around for mothering tips, and regularly checked with my Obstetrician-Gynecologist. During pregnancy, I didn’t drink alcohol, take prohibited drugs or any medicine my Ob-Gyne had not prescribed. I didn’t smoke nor stayed near people who smoked. I didn’t eat junk food, drink Coke, or slept late. I was frantic to know how and why.

Dra Ples had been very understanding and soothing because she assured me that it wasn’t, in anyway, my fault. Things like that happen everyday. It is more important to care for him now. Our frequent visits to the PHC also exposed me to the shocking reality that there were so many children with heart disease and congenital defects. And so I learned to be thankful that I have time with my son.

Dra Ples gave us time and suggested that we get another doctor’s opinion. We consulted with pediatricians at the Philippine Children’s Hospital, but we were given the same recommendation. Eventually, by the end of August, my son was cleared of his heart defects. We were so happy, we decided not to have his operation until we notice any change in his health condition.

My future race-car driver @ kindergarten

The following year, he became more physically active. He gained weight and his color changed. He continuously drank his milk. He didn’t turn purple when he cried. We had our happiest moments from then on.

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2 Ways to Detect Breast Cancer Through Elastography

A Boost to Early Breast Cancer Diagnosis in the Philippines 
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Unusual lumps on the breast are the common signs of breast cancer. Women beyond 30 are recommended to have regular mammogram to facilitate early breast cancer diagnosis. However, majority of patients with breast cancer have been diagnosed at a later stage. Cancer treatment at advanced stages is expensive and painful. Moreover, patients in advanced stages have higher risks considering that certain types of cancer can aggressively spread to adjacent areas.

Currently, women who are found to have a suspicious lump on the breast are recommended to have a mammogram test. A mammo procedure will require the patient to stand between plates for the X-ray. The breast must be as ‘flat’ as possible so that the ray can break through the least possible layers. It is especially painful when the procedure takes more than 20 minutes. The plates are studied and results made available after a few days, depending on the attending radiologist.

Painless and fast breast cancer diagnosis is now available through a new imaging technology, called the Ultrasound with Elastography. Pioneered by Hitachi Medical Corporation and exclusively distributed by Himex locally, the ultrasound provides real-time scanning, so you get instant result making breast cancer diagnosis immediate and increases the patient's survival.

Ultrasound Elastography started during the late 1990s and has since been widely studied in the US, Europe and other Asian countries. Like most new medical intervention, the elastogram withstood objections from different fields of medicine until multi-center and comparative studies revealed at least 99% accuracy of results. One particular study, lead by Dr. Jocelyn Cuyos of Jose R. Reyes Memorial Medical Center, was presented in a medical conference last October 23, 2010.

Tsukuba Scoring of Hitachi Medical Systems

Elastography is a non-invasive and painless ultrasound used to distinguish malignant from benign tumors. The sensitive equipment uses 2 ways in identifying malignant mass by color mapping and gauging hardness.

With the elastogram, the ultrasound uses Tsukuba Scoring. In contrast to the display of traditional ultrasound computers, the elastogram features a colored display of blue and green tones. Green massive areas show that the suspected lump is harmless, while areas in blue indicate malignant cell growth. The surrounding areas will show the extent of infection if the cancer has spread.

Cancer cells, generally, come from irregular cell growth and production. There are no clinically identified particular activities or direct factors that lead to cancer growth. Any irregularity in the body that disturbs regular cell growth and duplication can lead to the growth of tumors. These tumors can be cancerous, also called malignant, or non-cancerous, referred to as benign. Some malignant cells are aggressive; so it is pertinent to get immediate results to prepare a patient for early treatment.

Malignant cells are relatively 4 to 20 times harder than surrounding tissues. In verifying hardness, the new ultrasound automatically computes for fat-to-lesion ratio which will confirm whether the lump is benign or malignant. Fat to lesion ratio determines the breast tissues’ elasticity by comparing the suspected areas with the hardness of surrounding normal tissue. A score of 4 and above will confirm that the lump is malignant.

Jose R. Reyes Memorial Medical Center, Manila

As of now, only JRMMC has the real-time scanning elastogram in the Philippines. The JRMMC medical team will be studying its applicability and efficiency on cancer diagnosis in the thyroid within the next months. Worldwide, the elastogram has been used in early cancer diagnosis in the breast, thyroid, pancreas, splint, prostate and liver.

Ultrasound with Elastography @ JRMMC

The software was developed by Dr Ei Ueno and Dr Tsuyoshi Shiina of Tsukuba University in cooperation with Hitachi. The elastogram can detect and diagnose tumors as little as 2mm. With this intervention, women can be spared from the painful and possibly unnecessary mammography and biopsy. And of course, early diagnosis of breast cancer will increase the chances of survival of patients.

The service will soon be open to the public. Please contact JRMMC Radiology Department for more information, +632-712-7010. Follow me to get updates of hospitals that will offer elastography. Just a sneak peek: 2 new medical facilities in Mindanao will have the new Hitachi Ultrasound Diagnostic System.

Many thanks to Ms. Ana Margarita Trista, Ultrasound Specialist (Himex - JRMMC), for giving me an overview of some cancer diagnostic equipment and JRMMC’s initiatives in early cancer diagnosis; and to Ms. Paula Marie Gonzales, RRT, Ultrasound|CTI|MRI Specialist (Himex – JRMMC) for helping me understand how the elastogram works.

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8 Travel Insurance Benefits

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After my travel mishap yesterday, I made it a point to consult our family insurance expert, Mr. John Suedad. A comprehensive travel insurance provides medical reimbursement, personal accident benefit, reimbursement or replacement of lost baggage, travel and communication costs in obtaining lost travel documents and even personal liability of up to 6 months. Traveling longer? There is also a plan for annual coverage but it’s a little steep.

Comprehensive Travel Insurance

Let’s have a look at the products of one of the leading insurance companies: Chartis. Individuals up to 70 years old can apply for travel insurance. For those traveling with children, 1 to 18 years old, they are also protected with the same benefits as the insured except for the Personal Accident Benefit where they can get 50% of Php1M. Chartis, in particular, offers these benefits:

1.      Medical reimbursement for hospital confinement and medicine including professional fees, ambulance service and examination tests during your trip.

Though, you have to note that pre-existing conditions that occurred 6 months prior to your policy date do not qualify for this benefit. I suggest you get a health insurance recognized overseas to cover pre-existing conditions. You will be shocked to know that most overseas hospitals charge higher than tertiary hospitals in the Philippines. So, its best to prepare before you leave.

2.      Personal Accident lump-sum benefit for death and disablement. If in case of death, the insurer will shoulder Mortician services and transporting remains back to your place of origin. Without someone to facilitate your remains, it may take some time and a lot of paperchase for relatives to get your remains home.

3. If insured is hospitalized for more than 5 days, Chartis arranges and pays for transportation and accommodation of an adult family member to attend to your needs or accompany minor children you are traveling with.

Mr Suedad adds that the adult relative is given allowance for food and transportation together with the hotel and air fare.

4.      Medical evacuation to arrange for your transfer to another medical facility or return you to the Philippines.

You may need special care that the nearest hospital do not have. Thus, you will be transported to a facility that can best accommodate your needs. 

5.      Reimbursement or replacement of lost baggage due to theft or checked-in baggage is delayed for at least 12 hours. It covers damage to baggage due to hotel or aircraft personnel’s negligence. It even reimburses travel, accommodation, and communication costs in replacing travel documents that have been lost during the trip.

6.   If flight is delayed for more than 12 hours due to weather conditions, aircraft problem or airline strike, the insured will be reimbursed of all related expenses.

Flight delays and lost baggage are not uncommon in interconnecting flights. That’s why international airports now have 24-hour restaurants and benches where you can rest while you wait. But it’s neither safe nor relaxing to spend 12 hours (not even 6 hours!) at the airport.

I remember waiting around 18 hours in a bus station for an All Saints Day | All Souls Day trip with my parents when I was young. Apparently, the transport line did not have enough buses to cater to the overwhelming number of travelers for this occasion. Even if we had booked our tickets earlier, we had to wait for buses to return. It was such a headache. We never went out-of-town on those days after that nightmare.

7.      Reimbursement of travel fare and/or accommodation (if not refundable) if trip is cancelled or terminated due to death, serious injury or sickness of insured’s spouse, parent, parent-in-law, grandparent, child, siblings, business partner or co-director. Unexpected civilian commotion or riots at destination can also qualify for reimbursement if trip is cancelled 30 days before departure.

8.   Protects you from legal liability for damage to property or injury to third parties due to your negligence.

I suffered a severe headache from my misadventure at the Terminal 3 Airport yesterday. But I am looking forward to my next trip. This time I will plan ahead and get travel insurance.

Disclaimer: The benefits outlined herein are general descriptions only and do not constitute details of a contract. Maximum benefits vary from Php1M to Php2.5M. You may reach Mr John Suedad via e-mail: jaaasuedad@yahoo.com or you can refer to Chartis for more information.

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Lessons from My Travel Mishap

A woman’s instinct is her strength. I don’t know why for some reason, many of us disregard our instincts.

Airport Terminals in Manila

Yesterday, while in the cab en route to Terminal 3, with my 1 year old son, I fiddled with my cel to SMS my husband and my mom. Mom was on her way to Davao to pick us up. I wanted to keep her updated so she knows we’re on our way. It’s been 3 years since I took a flight alone with a toddler in tow. With kids, trips are fun but need a lot of preparation.

In 2007, I brought my elder son, then 2 years old, with me to visit my mom. We flew via General Santos. At the plane, there was an empty seat beside us so I sat him beside me and moving around wasn’t as difficult as getting all crammed up in a fully occupied 3-seater row. He simply played with the Cebu Pacific inflatable plane I got as his souvenir. This was not his first flight, though. At 4 months, he’s been to Bohol and at 5 months, we’ve taken him to Samar.

In his first flight, my husband and I were hesitant to travel with my eldest because he had VSD, a congenital heart defect. Even with complete vaccinations we were still worried that he might get sick during the trip. But his pedia-cardiologist gave him clearance so long as we strictly follow his scheduled medication. He was taking Lanoxin and a combination of diuretics. Along with his infant bottles and other emergency paraphernalia, his luggage was bigger than ours combined!

Last March, I’ve taken my 2 children to visit mom via Cotabato City. No, it’s not scary for someone who has been going in and out of South Cotabato at least once a year. Last I heard, the massacre site has been gaining popularity among tourists. I’m not sure if I can do the same, I mean stop and take photos.

Getting back to our story, I remember it was such a smooth ride I wanted to take my younger son for my visit this year. I had wanted to get a travel insurance for me and my son because I was scheduled to go to several provinces apart from Davao. I know my sons are different but I guess I expected too much from this trip. In the cab, my 1-year-old son could not help but fiddle with the interiors. So the entire cab ride became a wrestle in trying to keep him to sit still and from crossing over the front seat! I just hoped I don’t drop anything valuable when we alight later, I thought.

As we neared Terminal 3, I sent mom a final message and slipped my cel in my jean pocket. I arranged our luggage into the trolley and carried my son. It’s off season but the line is still long at the entrance. As I was emptying my pocket for the X-ray check I realized I didn’t have my phone anymore. So I asked the guard to have a look at our luggage as I hurriedly ran to try to catch our cab. Well, I knew it was already some minutes and was just hoping (against hope) that I’d still find the cab.

No luck! As we were walking back to the terminal’s entrance, my anxious son suddenly threw up. At first, it was in bearable quantities. I was exhausted from running (I still had my backpack where I kept my laptop and my son on the eezy-lift baby carrier). I had to line up again for the X-ray and locate my other bag. He throws up one more, big time. So I had to change his clothes and clean him up. Good thing I had 2 packs of wet wipes. By the time I reached Cebu Pacific's check-in counter I was denied because I was late already. Sheer luck, huh! I wasn’t able to track time because I was frantic looking for a way to get my cel back and was preoccupied getting my son cleaned up. I could book the next flight but I began to worry that I won’t be able to find my mom in Davao if I didn’t have my cel. I couldn’t call because she was using a new number and I hadn’t memorized it! Who does?

Several lessons learned.

1. Listen to my instincts rather than say ‘I knew it and should’ve done this or done that…’
2. Get travel insurance. It would’ve covered me the minute I left the house!
3. Backup your phonebook now. Check the installation cd that came with your mobile phone and setup your phone's application in your computer. Update your backup every time you get new contacts. And always keep a list of most important numbers with you. You’ll never know when you’ll need the list.
4. Always put your cel in the bag, not in your pocket where it can slip unknowingly. My husband has lost several mobile phones because he always keep them in his trouser pocket.
5. Be alert and take care of valuable things when in public transport. Unless the driver is kind enough to return your things, there is no way you can get it back. This is my second time, and I’ve learned enough. (I sure hope so)

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