geriatricsphilippines.org Blog

In support of the Save the Ilog Pasig Project, thousands of runners (and walkers) flocked to the Mall of Asia today 10.10.10

The song Mutya ng Pasig by Nicanor Abelardo highlights a woman’s love for humanity, here beautifully sung by Conching Rosal in this You Tube video The photo montage (courtesy of Alfredo Villanueva) shows glimpses of the old beautiful Pasig River and Manila, from 1898 to 1930.

[caption id=”attachment_545″ align=”aligncenter” width=”288″ caption=”The old Pasig River”][/caption]
Kung gabing ang buwan sa langit ay nakadungaw
Tila ginigising ng habagat sa kanyang pagtulog sa tubig

Ito ang Mutya ng Pasig …… Ito ang Mutya ng Pasig!

Sa kanyang pagsiklot sa maputing bula
Kasabay ang awit, kasabay ang tula:

Dati akong paraluman sa kaharian ng pag-ibig
Ang pag-big nang mamatay,
Naglaho rin and kaharian

Ang lakas ko ay nalipat
Sa puso’t dibdib ng lahat

Kung nais niniyong ako’y mabuhay,
Pag-ibig ko’y inyong ibigay

Kung nais niniyong ako’y mabuhay,
Pag-ibig ko’y inyong ibigay!

May our passionate love for country save the Ilog Pasig and Mother Earth!

There are two major types of throat cancer : Hypopharyngeal (ex. Laryngeal) and Nasopharyngeal.
[caption id=”attachment_530″ align=”aligncenter” width=”238″ caption=”Nasopharynx”][/caption]
The American Cancer Society reports that there are 12,720 new cases of laryngeal cancer (10,110 in men and 2,610 in women) in 2010. This type of cancer usually involves the glottis, the area containing the vocal cords.

The symptoms of laryngeal cancer are hoarseness, a persistent sore throat, constant coughing, pain when swallowing, difficulty swallowing, ear pain that won’t go away, difficulty breathing, weight loss, and a lump or mass in the neck.

Nasopharyngeal cancer is highly prevalent among persons of Asian and African ethnicity. This type of cancer occurs behind the nose and above the throat.

The symptoms of nasopharyngeal cancer are a lump in the neck or lymph nodes, hearing loss, ringing in the ear, fullness in the ear (especially on one side only), recurrent ear infections, nasal blockage or stuffiness, nosebleeds and facial pain.

Risk factors for throat cancer are:
Tobacco/smoking
Alcohol

People who use both tobacco and alcohol have the highest risk of all. Combining these 2 habits doesn’t just add both risks together, it actually multiplies them. Some reports have found that people who smoke and drink are up to 100 times more likely to get head and
neck cancer than are people with neither habit.

Poor nutrition and vitamin deficiency
- salted fish and meat (tuyo, tapa, tocino)
Viruses : Human Pappiloma Virus (laryngeal tumor) and Epstein-Barr Virus (nasopharyngeal)
Weakened immune system
Genetics and family history
Longterm and intense exposures to wood dust, paint fumes, formaldehyde, and certain chemicals used in the metalworking, petroleum, plastics, and textile industries.

Prevention of this type of cancer is possible. The following are advised:

Quit smoking
Limit alcohol intake
Eat more 5 servings of fresh fruits and vegetables daily
Reduce intake of cured and salted fish or meat
Improve workplace ventilation

Source: American Cancer Society

Calcium supplements are commonly prescribed to prevent and manage osteoporosis.

A few randomized trials on calcium supplements have shown an increased risk of cardiovascular adverse events in women taking calcium supplements. (Reid et al Am J Med 2006;119:777-85 and Bolland et al BMJ 2008;336:262-6)

[caption id=”attachment_523″ align=”aligncenter” width=”164″ caption=”osteoporotic hipfracture”][/caption]

A newly published meta analysis of clinical trials of calcium supplements (Bolland et al BMJ 2010 341 c3691) shows that calcium intake increases the risk of heart attacks (myocardial infarction) by 30%.

In this meta analysis, 15 trials were eligible for inclusion, five with
patient level data (8151 participants, median follow-up 3.6 years, interquartile range 2.7-4.3 years) and 11 with trial level data (11 921 participants, mean duration 4.0 years). The number of subjects in the analysis totalled 12,000 participants.

In the five studies contributing patient level data, 143 people allocated to calcium had a myocardial infarction compared with 111 allocated to placebo (hazard ratio 1.31, 95% confidence interval 1.02 to 1.67, P=0.035)

The authors conclude that calcium supplements (without co-administered vitamin D) are associated with an increased risk of myocardial infarction. As calcium supplements are widely used these modest increases in risk of cardiovascular disease might translate into a large burden of disease in the population.

Studies on Vitamin D with or without calcium are also warranted.

The following study demonstrated that

Aspirin was not effective in the primary prevention of
cardiovascular events in patients with asymptomatic peripheral arterial disease and diabetes. Antioxidants showed no benefit on cardiovascular events in this population.

Study Title: The prevention of progression of arterial disease and
diabetes (POPADAD) trial: factorial randomised placebo
controlled trial of aspirin and antioxidants in patients with
diabetes and asymptomatic peripheral arterial disease

Authors:
Jill Belch, Angus MacCuish, Iain Campbell, et al.

Citation: BMJ 2008;337:a1840 doi:10.1136/bmj.a1840

Background:
Aspirin is effective in the secondary prevention of cardiovascular events in patients with symptomatic peripheral arterial disease and with or without diabetes. However, the role of aspirin and antioxidants in primary prevention is not clear.

The study’s main objective was to determine whether aspirin and antioxidant therapy, combined or alone, are more effective than
placebo in reducing the development of cardiovascular events in patients with diabetes mellitus and asymptomatic peripheral arterial disease.

Subjects: 1276 adults aged 40 or more with type 1 or type 2 diabetes and an ankle brachial pressure index of 0.99 or less but no symptomatic cardiovascular disease. Baseline characteristics were equal in all groups. Average age was 60 years. Approximately 53% were women. Mean HBA1c level was 8%.

Method: Multicentre, randomised, double blind, 2×2 factorial, placebo controlled trial.

Intervention:
The interventions were daily aspirin 100 mg or placebo tablet, plus antioxidant or placebo capsule. The antioxidant capsule contained α-tocopherol 200 mg, ascorbic acid 100 mg, pyridoxine hydrochloride
25 mg, zinc sulphate 10 mg, nicotinamide 10 mg, lecithin 9.4 mg, and sodium selenite 0.8 mg

Conclusions: This trial does not provide evidence to support
the use of aspirin or antioxidants in primary prevention of cardiovascular events and mortality in the population with diabetes studied.

A well written article on caring at the end of life when cure is not the goal.

Letting Go
What should medicine do when it can’t save your life?

Atul Gawande The New Yorker July 2010

Excerpt:

“It has become, in my view, a bit too trendy to regard the acceptance of death as something tantamount to intrinsic dignity,” he wrote in his 1985 essay. “Of course I agree with the preacher of Ecclesiastes that there is a time to love and a time to die—and when my skein runs out I hope to face the end calmly and in my own way. For most situations, however, I prefer the more martial view that death is the ultimate enemy—and I find nothing reproachable in those who rage mightily against the dying of the light.”

I think of Gould and his essay every time I have a patient with a terminal illness. There is almost always a long tail of possibility, however thin. What’s wrong with looking for it? Nothing, it seems to me, unless it means we have failed to prepare for the outcome that’s vastly more probable.

The trouble is that we’ve built our medical system and culture around the long tail. We’ve created a multitrillion-dollar edifice for dispensing the medical equivalent of lottery tickets—and have only the rudiments of a system to prepare patients for the near-certainty that those tickets will not win. Hope is not a plan, but hope is our plan.

Atul Gawande is the author of Better and Complications. He is also a MacArthur Fellow, a general surgeon at the Brigham and Women’s Hospital in Boston, a staff writer for The New Yorker, and an assistant professor at Harvard Medical School and the Harvard School of Public Health.

From COMADD NIH Faculty Member Prof JD
March 13, 2010 2:00 pm

Nakapagtatakang di maunawaan.

Paninigarilyo’y di dapat simulan.

At kung nakaranas dapat ay tigilan.

Walang maidudulot kundi kasamaan.

Ito ay dahilan ng sakit na kanser.

Sakit din sa puso at iba pang klase.

Dahil ang panganib ay mas lumalaki.

Nikotinang sangkap siyang dumadale.

[caption id=”attachment_473″ align=”aligncenter” width=”96″ caption=”Cigarette-puffing Elderly”][/caption]

Isa pang masama’y amoy ng hininga.

Malayo ka pa lang simoy di maganda.

Kahit magsepilyo o maligo ka pa.

Amoy ng sigarilyo ay nakadikit na.

Maging perang laan para sa pagkain.

Kung nagsisigarilyo’y gutom titiisin.

Di ba naiisip ulcer ang aabutin.

O iba pang sakit kung iyong iisipin.

Batid nga ba ito ng nakararami?

O ang kabataa’y bulag nga o bingi?

Di nila makitang talagang posible.

Ang buhay na nila’y maigsi sa dati.

Kaya’t sana nama’y inyo ng isumpa.

Itong sigarilyong salot nga sa lupa.

Sinusunog nito ang pera at baga.

Dahil may adiksyong kadikit na sadya.

Dahil ang biktima’y lalong dumarami.

Kailangan pa bang sadyang makumbinsi.

Paninigarilyo ay hindi mabuti.

Baka mahuli na itong pagsisisi.

If you are of average risk (no family history of colon cancer, inflammation in colon), colon cancer screening should begin at age 50. Several screening options exist — each with its own benefits and drawbacks. Talk about your options with your doctor, and together you can decide which tests are appropriate for you.

Guidelines issued by the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer and the American College of Radiology include several options for colon cancer screening:

* Annual stool occult blood testing
* Flexible sigmoidoscopy every five years
* Double-contrast barium enema every five years
* Colonoscopy every 10 years
* Virtual colonoscopy (CT colonography) every five years
* Stool DNA testing — new screening approach; test is available, but not certified by the Food and Drug Administration; research under way to increase accuracy and determine how often test should be done

More frequent or earlier screening may be recommended if you’re at increased risk of colon cancer. Discuss the benefits and risks of each screening option with your doctor. You may decide one or more tests are appropriate for you. One factor to consider is whether your health insurance covers colon cancer screening.

[caption id=”attachment_461″ align=”aligncenter” width=”184″ caption=”Colon and Intestines Adam”][/caption]
If you are at high risk for colon cancer, medications and surgery have been found to reduce the risk of precancerous polyps or colon cancer. However, not enough evidence exists to recommend these medications to people who have an average risk of colon cancer. If you have an increased risk of colon cancer, you might discuss the benefits and risks of these preventive treatments with your doctor:

* Aspirin. Some evidence links a reduced risk of polyps and colon cancer to regular aspirin use. However, studies of low-dose aspirin or short-term use of aspirin haven’t found this to be true. It’s likely that you may be able to reduce your risk of colon cancer by taking large doses of aspirin over a long period of time. But using aspirin in this way is likely to cause side effects, such as gastrointestinal bleeding and ulcers.
* Nonsteroidal anti-inflammatory drugs (NSAIDs) other than aspirin. This class of pain-relief medications includes drugs such as ibuprofen and naproxen. Some studies have found NSAIDs may reduce the risk of precancerous polyps and colon cancer. But side effects include ulcers and gastrointestinal bleeding. Some NSAIDs have been linked to an increased risk of heart problems.
* Celecoxib. Celecoxib and other drugs known as COX-2 inhibitors work similarly to NSAIDs to provide pain relief. Some evidence suggests COX-2 drugs can reduce the risk of precancerous polyps in people who’ve been diagnosed with these polyps in the past. But COX-2 drugs carry a risk of heart problems, including heart attack. Two COX-2 inhibitor drugs were removed from the market because of these risks.
* Surgery to prevent cancer. In cases of rare, inherited syndromes such as familial adenomatous polyposis, or inflammatory bowel disease such as ulcerative colitis, your doctor may recommend removal of your entire colon and rectum in order to prevent cancer from occurring in the future.

More from Mayo Clinic

The newly signed Expanded Senior Citizens Act 0f 2010, RA 9994 includes discounts for vitamins, minerals, diapers, and essential medical supplies. This includes Calcium for osteoporosis, Iron tablets for anemia, and B complex for patients with neuropathy.

However, 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. This excludes those classified as “food supplements with no approved therapeutic claim”.

This law also mandates that DOH is to provide free pneumoccocal and influenza vaccines to indigent senior citizens.

Moreover, 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.[caption id=”attachment_440″ align=”aligncenter” width=”300″ caption=”Wheelchair”][/caption]

The Implementing Rules and Regulations (IRR) of Republic Act 9994 (Expanded Senior Citizens Act of 2010) went into effect on July 6 granting the full 20 percent discount - privileges to senior citizens.

Secretary Soliman emphasized that senior citizens who have queries and complaints may call the DSWD hotlines 951-7120 and cellphone number 0999-314-7425 or visit the National Coordinating and Monitoring Board (NCMB) website at http://ncmb.dswd.gov.ph and email at ncmb@dswd.gov.ph

“We also plan to set-up Help Desks at the DSWD Central Office and in all DSWD Regional Offices for senior citizens without access to phone lines and the internet,” Secretary Soliman added.

Secretary Soliman appealed to senior citizens to refrain from abusing the privileges under RA 9994. “The law is the government’s way of acknowledging and giving praise to senior citizens who contributed to nation building, and is designed for the sole enjoyment of the senior citizens, so please do not abuse these privileges,” Secretary Soliman stated.

[caption id=”attachment_432″ align=”aligncenter” width=”287″ caption=”DSWD Sec Dinky Soliman “][/caption]

Lifestyle Diseases (Sakit sa Puso)

Sinulat ni JD Agapito

Sa dami ng sakit sa ating lipunan

Sakit ng katawan ay kayang pigilan

Lalo na’t sa puso ang pag-uusapan.

Disiplina ang siyang tanging kailangan

Bakit ko nasabi ang huli kong linya?

Dahil ang sakit ay tayo ang may gawa.

Alam na masamang kumain ng taba.

Hanap nitong dila’y karneng mamantika.

Kung may pera nama’y panay rin ang punta

Sa mga food chains na prito ang siyang tinda.

Sa order na chicken, balat ang inuuna.

Mataas na kolesterol siyang ‘di iniinda.

Bukod pa nga rito’y ang hindi paggalaw.

Panay ang pag-upo’t di man lang sumayaw.

Kahit na minsan lang sa buong isang araw.

Maglakad lakad ng taba ay matunaw.

Maging sa inumi’y di displinado.

Kung uminom ng softdrinks sadyang bigay todo.

Dapat ay minsan lang sa buong ‘sang linggo.

Mas maraming tubig ang dapat sa iyo.

Kaya’t mas marami ang may hypertension.

Dahil sa kinai’y mayr’ong alta presyon.

Dagdagan pa natin ng lahat ng tensyon.

Dala na rin mismo ng mga sitwasyon.

Kaya kung ikaw ay hindi magbabago.

Lalo pa kung ika’y naninigarilyo.

Tiyak ang buhay mo ay mamimiligro.

Sakit sa puso ang tatapos sa iyo.

Dito sa aking tula ‘y may hihilingin.

Pwede bang pagkain ay sadyang isipin

Para makontrol ang taba maging asin.

Mga simpleng bagay ‘wag ng problemahin.

Kaya’t sana ay hindi pa mahuli.

Itong aking payong hangad ay mabuti.

Upang maiwasan itong maatake.

At di na mangyari itong pagsisisi.

Dahil may dalanging kasama ang tula.

Itaas sa Diyos ang nais na sadya.

Sa kanyang patnubay lahat magagawa.

Kung buhay ay maayos, siya’y matutuwa.

Contributed by COMADD NIH Member
Prof JD
June 28, 2010 5:00