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From Manila Bulletin

Ang tanda
The View from Rizal
By GOV. JUN A. YNARES, M.D.
July 24, 2011, 8:00am

MANILA, Philippines — I spotted the ever-present Lolo Sisong at a recent gathering of civic leaders in Antipolo, Rizal.

The event was one of several organized by outstanding nongovernmental organization (NGO) partners of the Rizal provincial government like the United Bayanihan Foundation. This one had to do with government and private sector putting their heads together. The aim: Help senior citizens remain productive and happy.

I know no senior citizen more intellectually productive than the inimitable Lolo Sisong, Rizal province’s self-appointed official sage. So, in that meeting where those who are superior in wisdom and years were the subject matter, the Lolo ng Lalawigan’s presence was a welcome one.

Since the word “matanda” (old) kept ringing throughout the event, I decided to signal Lolo Sisong to join my huddle with NGO leaders and ask him a question I had secretly asked myself for years.

The question: Why are those who are advanced in years called “matanda”?

“Why ask me, I am not old enough to answer the question,” Lolo Sisong said with his serious humor glowing in his face.

“It takes a young person to answer the question,” I answered, smiling, knowing he would bite the bait.

“Okay, then, I will answer the question,” Lolo Sisong said, pretending to capitulate.

“You see, Junjun, ‘matanda’ comes from the word ‘tanda’,” he began.

“So, therefore?” I egged him to make it quick.

“Well, ‘Tanda’ has three meanings,” he seemed naughtily dragging the conversation.

“Go ahead, what are they?” I asked, impatient.

“One, ‘tanda’ means ‘mark’,” he started the long process of sagely enumeration.

“Two, ‘tanda’ means ‘sign’,” Lolo Sisong continued.

“Three, ‘tanda’ means ‘recall’ or ‘remember’, or ‘reminisce’,” he ended.

“Care to explain?” I asked again, impatience growing.

“That’s where I’m going,” he answered, seemingly irked by my nagging.

“You see, a senior person has a lot of ‘tanda’ in his body and in his character – the marks of what he has gone through in life,” Lolo Sisong said. “His body and his personality shows the many marks of the happy and painful experiences that the senior person has gone through,” he added.

“Now, the quality of his body, his mind and his character as shaped by those experiences shows whether or not they made him into a better person… or a bitter one,” Lolo Sisong explained.

“So, when you see a senior person, you look at the ‘marks’ to determine what kind of person he is,” he essayed.

Impressed by the wisdom, I said, “Move on to number two – ‘tanda’ meaning ‘sign’.”

“Be patient, I am old, remember?” he answered, even more irked.

“Okay, ‘tanda’ also means ‘sign’,” he moved on. “Senior people are either ‘warning signs’ or signs similar to the beacon light of a lighthouse,” Lolo Sisong said, choosing his words carefully.

“When you find a bitter old person, he is a warning sign to you – don’t go where he went, such as his vices and his scheming ways,” he explained. “But when you find a ‘better’ senior person, ask him which path he chose and follow it – he is showing you a beacon light,” Lolo Sisong added.

I was silent, reflecting.

“May I go to point number three,” Lolo Sisong said, obviously trying to irk me reciprocally.

“Please go ahead,” I answered serious this time.

“Well, ‘tanda’ also refers to that big vault of memories of the many years we have gone through in life,” he began his final point.

“That is the gold mine of our advanced years – the definite advantage of being senior over being young,” Lolo Sisong moved on.

“We can open that vault anytime to retrieve the things that matter a lot to people – memories of love and joy, of friends and loved ones, of the many valuable experiences which prove to us that we did spend our years wisely,” he said, his aging eyes all of a sudden looking young.

“And if a senior person is generous, he lets young people into that vault and lets them frolic in the gold mine of precious memories,” he said, using his poetic abilities.

I was still silent, awed by the obvious advantage in wisdom that senior people have.

“That’s also what we mean by ‘growing old gracefully’, Junjun”, Lolo Sisong attempted to conclude.

“One ages well by being conscious of his role as ‘mark’, ‘sign’ and ‘treasure trove of memories,” he said.

“So, be careful about how experiences make their mark on you,” he continued.

“Be conscious about your role – are you a danger sign or a beacon light to the younger generation,” he moved closer to his closing.

“And consciously build the kind of memories that you bring into your vault,” he, at last, ended.

“Gotta go,” Lolo Sisong said, acting like a busy young person.

“Thanks much,” I said, trying to memorize his key points.

“By the way, those three things are also a technique on how one stays young despite advancing years,” Lolo Sisong post-scripted.

“Will remember that,” I answered.

“Only if your mind can stay young like mine,” Lolo Sisong said, underscoring that the last word is always his.

I kept my mouth shut, impressed by how he has, indeed, made great use of his years.

Feedback: provinceofrizal@yahoo.com

Authors: Silvina Levis, MD; Nancy Strickman-Stein, PhD; Parvin Ganjei-Azar, MD; Ping Xu, MPH; Daniel R. Doerge, PhD; Jeffrey Krischer, PhD

Journal: Arch Intern Med. 2011;171(15):1363-1369. doi:10.1001/archinternmed.2011.330

A 2- year randomized trial found no significant difference in bone loss or menopausal symptoms between women taking soy tablets or placebo.

Patients were women age 45-60 years, within 5 years of menopause and without osteoporosis.

Subjects were were randomly assigned, in equal proportions, to receive daily soy isoflavone tablets, 200 mg, or placebo.

Results
After 2 years, no significant differences were found between the participants receiving soy tablets (n = 122) and those receiving placebo (n = 126) regarding changes in bone mineral density in the spine (–2.0% and –2.3%, respectively), the total hip (–1.2% and –1.4%, respectively), or the femoral neck (–2.2% and –2.1%, respectively).

A significantly larger proportion of participants in the soy group experienced hot flashes and constipation compared with the control group. No significant differences were found between groups in other outcomes.

Authors’ Conclusions
In this population, the daily administration of tablets containing 200 mg of soy isoflavones for 2 years did not prevent bone loss or menopausal symptoms

FDA approves injectable gel to treat fecal incontinence

For Immediate Release: May 27, 2011
Media Inquiries: Amanda Sena, 301-796-0393, amanda.sena@fda.hhs.gov
Consumer Inquiries: 888-INFO-FDA

The U.S. Food and Drug Administration today approved a sterile, injectable gel to treat fecal incontinence in patients for whom other therapies such as diet change, fiber therapy or anti-motility medications failed.

Fecal incontinence is the involuntary loss of bowel control. It can have different causes including nerve damage, weakened anal sphincter associated with aging, or rectum muscle damage. According to the National Institutes of Health, there are more than 5.5 million Americans with fecal incontinence.

The Solesta gel is injected into a layer of tissue beneath the anus lining and may help build tissue in that area. By growing the surrounding tissue, the opening of the anus narrows and the patient may be able to better control those muscles.

“Fecal incontinence is difficult to treat,” said Christy Foreman, director of the Office of Device Evaluation at the FDA’s Center for Devices and Radiological Health. “This approval provides a minimally invasive treatment option for patients with fecal incontinence that does not respond to conservative therapies.”

The FDA based its approval on results from a clinical study of 206 patients. In the primary study, most patients received two treatments, consisting of four injections each, for a total of eight injections. After six months, more than half of the patients injected with Solesta experienced a 50 percent reduction in the number of fecal incontinence episodes. However, one-third of patients who received no Solesta in the study also experienced a similar reduction. Overall, a greater proportion of patients treated with Solesta experienced improvements, indicating the gel provides benefit.

Solesta is approved for use in patients ages 18 and up. It should not be used in patients who have active inflammatory bowel disease, immunodeficiency disorders, previous radiation treatment to the pelvic area, significant rectal prolapse, active infections, bleeding, tumors or malformations in the anorectal area, rectal distended veins, an existing implant in the anorectal region, or allergy to hyaluronic acid based products.

The most common side effects associated with Solesta include injection area pain and bleeding. Infection and inflammation of anal tissue are more serious risks, but are less common.

Solesta is manufactured by Oceana Therapeutics Inc. of Edison, N.J.

Other treatments for fecal incontinence include dietary modification, antidiarrheal medication, and exercises to strengthen the sphincter. If those conservative therapies don’t work, some patients undergo surgical treatments including sphincteroplasty or sphincter repair, implantation of an artificial bowel sphincter, radiofrequency ablation of the tissue of the anal canal and ileostomy/colostomy surgical repair.

For more information:

Gastroenterology-Urology Devices Panel Advisory Committee Meeting Transcript from Dec. 2nd1 and Dec. 3rd2, 2010.

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

Developed by:
American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents American Academy of Neurology American Geriatrics Society American Society for Preventive Cardiology American Society of Hypertension, American Society of Nephrology Association of Black Cardiologists European Society of Hypertension

Clinical Evaluation

Note: The reader should view the expert consensus document as the best attempt of the ACCF and document cosponsors to inform and guide clinical practice in areas where rigorous evidence may not yet be available or evidence to date is not widely applied to clinical practice.

Aside from a good and targeted history and physical examination, guidelines on laboratory testing were presented. The diagnosis is established with at least 3 blood pressure readings in at least 2 clinic visits.

Ambulatory BP monitoring (ABPM) is indicated when hypertension diagnosis or response to therapy is unclear from office visits, when syncope or hypotensive disorders are suspected, and for evaluation of vertigo and dizziness. The case for using out-of-office BP readings in the elderly, particularly home BP measurements, is strong due to potential hazards of excessive BP reduction in older people and better prognostic accuracy versus office BP.

The most important role for testing in an elderly patient
with hypertension is to assess for organ damage and modifiable
CVD risk factors, including tobacco smoking, hypercholesterolemia,
diabetes mellitus, and excessive alcohol intake.

Information on the following laboratory tests should be available:
1. Urinalysis to look for any evidence of renal damage,
especially albuminuria/microalbuminuria
2. Blood chemistry to assess electrolytes and renal function, especially potassium and creatinine with eGFR
3. Total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides, preferably fasting levels
4. Fasting blood sugar and, if there are concerns about diabetes mellitus, hemoglobin A1c
5. ECG

Lifestyle Modification

Weight reduction, salt reduction, DASH diet, regular physical activity and moderation in alcohol consumption are recommended.

The general recommended BP goal in uncomplicated hypertension is 140/90 mm Hg. However, this target for elderly hypertensive patients is based on expert opinion rather than on data from randomized controlled trials (RCTs). It is unclear whether target SBP should be the same in patients 65 to 79 years of age as in patients 80 years of age.

Drug Treatment and other details may be viewed thru this link to the Journal of the American College of Cardiology Expert Consensus Document on Hypertension in the Elderly 2011

The Alzheimer’s Association USA released the following Alzheimer’s Disease Facts and Figures 2011.
Go to the link to access the following information:

• Overall number of Americans with Alzheimer’s disease nationally and for each state
• Proportion of women and men with Alzheimer’s and other dementias
• Estimates of lifetime risk for developing Alzheimer’s disease
• Number of family caregivers, hours of care provided, economic value of unpaid care nationally and for each state, and the impact of caregiving on caregivers
• Use and costs of health care, long-term care and hospice care for people with Alzheimer’s disease and other dementias
• Number of deaths due to Alzheimer’s disease nationally and for each state, and death rates by age

Alzheimer’s is the sixth-leading cause of death in United States and the only cause of death among the top 10 in the United States that cannot be prevented, cured or even slowed. Based on mortality data from 2000-2008, death rates have declined for most major diseases while deaths from Alzheimer’s disease have risen 66 percent during the same period.

The conclusions in this report reflect currently available data on Alzheimer’s disease. They are the interpretations of the Alzheimer’s Association.

Details are available in the website Alzheimer’s Association

The DSM-5 Task Force and Work Group members (American Psychiatric Association) are working to develop criteria for diagnoses that not only reflect new advances in the science and conceptualization of mental disorders, but also reflect the needs of our patients.

The Neurocognitive Disorders Work Group has been responsible for addressing these disorders. Among the Work Group’s proposals is the recommendation that the category be divided into three broad syndromes: Delirium, Major Neurocognitive Disorder, and Mild Neurocognitive Disorder. The Neurocognitive Disorders Work Group has posted the draft criteria for the Alzheimer Disease Subtype as an illustration of how they propose to organize other subtypes. They are inviting comment on the general approach. Work on other subtypes is currently in progress, and the Work Group is in consultation with various expert groups that work in those areas (e.g. vascular cognitive impairment and dementia, frontotemporal lobar degeneration, dementia with Lewy bodies, Huntington’s disease, Parkinson’s disease, traumatic brain injury, etc.).

While they welcome comments and suggestions on any and all aspects of the proposal, they are particularly interested in obtaining input regarding the following issues:

1) Removing the term “Dementia” and adding “Major Neurocognitive Disorders”,

2) Adding a category of “Mild Neurocognitive Disorders”,

3) Categorizing behavioral disturbances, particularly the syndromes of psychosis and depression, associated with Neurocognitive Disorders, and

4) Selecting specific domains as well as measures of severity of cognitive functional impairment

Please Click this link to DSM 5 Delirium, Dementia, Amnestic, and Other Cognitive Disorders

Numerous senior citizens and longterm care homes for the elderly are denied their 20% discount when purchasing vitamins and diapers from major drugstores or distributors.

The DOH and FDA have clarified that discounted drug and medicine purchases, now extend to vitamins and minerals specifically prescribed by doctors for senior citizens for purposes of prevention, treatment, or diagnosis of a disease or illness. However, they still exclude those classified as “food supplements with no approved therapeutic claim”.

Vitamins and drugs in the form of syrup/suspension initially intended for pediatric consumption are also included if prescribed by a physician to an elderly patient.

The 20% discount also extends to the purchase of essential medical supplies, accessories or equipment like eyeglasses, dentures, hearing aids, walkers or wheelchairs, and even to geriatric diapers.

Likewise, the Energy Regulatory Commission (ERC) recently issued Resolution No. 23. Series of 2010 to serve as supplemental guidelines in the implementation of Republic Act No. 9994 or the Expanded Senior Citizens Act of 2010.

The ERC guidelines limits the discount privilege to the “exclusive use and enjoyment” of seniors. As such, senior citizens centers and residential facilities or groups homes must have a separate meter and must be strictly utilized by elderly clientele alone. For households, personal consumption of elderly residents is measured by a limitation of 100 kilowatt hours power utilization, and anything higher than 100 kwh will no longer qualify them for the 5% electricity discount.

Resources:
Department of Health AO 2010 0032 (signed 09 October 2010)

DSWD RA 9994 Frequently Asked Questions

Implementing Rules and Regulations RA 9994

DOH Guidelines to Implementing RA 9994

Philippine National Drug Formulary Vitamins

Meralco Electricity Senior Discount

WHEN: November 18-19, 2010

WHERE: San Lazaro Hospital Auditorium, Quiricada Street Sta. Cruz, Manila

The Vaccine Study Group, a research study group under the UP Manila – National Institutes of Health (NIH) has initiated and organized a Clinical Vaccinology Course for Health Care Providers, in cooperation of Philippine Foundation for Vaccination (PFV), Aging Study Group-NIH, San Lazaro Hospital and Society of Adolescent Medicine of the Philippines (SAMPI).

The main objective of the course is to give an overview and update in the field of vaccinology so that participants to the course will be confident to use vaccines both in clinical practice and as a public health intervention. The group believes that vaccination is the most effective control measure for diseases and would lead to an improvement of the health and economic status of communities and nations.

The course will be conducted by a group of distinguished professors, scientist and public health experts who have received basic and advanced vaccinology courses in France, Korea and other reputable vaccine institutions to enable them to give you what you would want to know most about vaccines.

HOW: Please contact the following to register (P2500.00 for two (2) days per registrant) or give a donation to our cause.

Dr Lulu C Bravo - Mobile No.: +6319189215998 or NIH 632-5254266 INTROP office: 5269167 PFV office: 567-2397.

Visit Link to Vaccinology Course Details

Philippine Society of Geriatric Medicine – Asia Pacific Geriatric Conference January 19-21, 2011, Cebu City, Philippines

The Organizing Committee through its Research Committee invites submission of abstracts in geriatrics and gerontology consistent with its theme, “Sharing and Integrating Best Practices in Geriatrics in the Asia Pacific Region.” These abstracts should be original and not be published elsewhere at the time of submission. A copy of the Institutional Review Board approval letter must be submitted for research abstracts.

Click here for Abstract submission detials

Excerpt from Marjorie Gorospe, loQal.ph

115-year-old I-Apayao native Rufina Daluyon reflects the healthy lifestyle of the I-Apayao tribe and despite her age, the centenarian shows no signs of serious illness.

Apo Rufina can still talk and can still walk but she only speaks Ilocano. She shares her stories to willing listeners through her great granddaughter Susan.

1. Lifelong Physical Activity
The I-Apayao tribe is related to Isneg tribe and both tribes are known as good farmers.

2. Diet - mostly vegetables
Susan says being a member of the I-Apayao tribe, Apo Rufina is very fond of vegetables.

3. Good Genes
Apo Rufina’s husband lived for 126 years. Apo Rufina has three children, but only one among the three is still alive at a still remarkable age of 90.

4. Spirituality and Gratitude

5. Discipline
“Napakahigpit nya (Rufina) lalo pagdating sa pag-uwi ng maaga sa bahay at tamang pagkain. (She is very strict, particularly on curfews and eating the right food),” says Susan in jest.

[caption id=”attachment_453″ align=”aligncenter” width=”300″ caption=”Centenarian Northern Philippines”][/caption]

“Minsan tinatanong na rin nya kung bakit di pa sya namamatay at mukha daw nalimutan na siya ni Lord sunduin. (She often wonders why she’s still alive and that the Lord probably has forgotten about her),” says Susan who often visits her great grandmother and gives her a shower.

For her part, Susan says she is thankful for the life that God has granted Apo Rufina.

But Susan admits that things are getting harder for Apo Rufina. Susan says all they can do is to give her the love that she deserves while she is still alive.