Do you have what it takes to run as a team, represent your province for a chance to win P3 million cash?
Laban ng Lahi 2018 is inviting 33 runners from your province or town to run as one and compete with different regions all over the country.
A global and unique 18-km team marathon challenge, Laban ng Lahi 2018 is a tourism-for-a-cause and peace revolution advocacy project with the goal of achieving national reconciliation set on September 11 in Brgy. La Union, Cabadbaran City, Agusan Del Norte.
Team who wins first prize gets P3 million cash tax-free, P1 million worth of road concreting project, and P350,000 for any chosen charitable institution; second prize wins P800,000 cash tax-free and P100,000 for the chosen charitable institution, third prize wins
The competition is a race challenge format where criteria of judging include shortest time (65 percent), team presentability (tailor-made uniform or body painting uniform) (13 percent), chanting (5 percent), team work (9 percent), and team support (8 percent).
The team should compose of one team manager, one assistant manager/team dietitian/therapist, and 30-31 actual members.
A local team must have at least three female runners. Maximum of 10 foreigners (if there are any), otherwise the team will become a foreign team.
For foreign team, it must have at least two foreign female runners and one Philippine passport holder female runner. It must have at least three Philippine passport holder runners (two males and one female).
How to register
Registration fee for local team is P2,000 per person or member or P66,000 per team; for foreign team, P3,000 per member or P99,000 per team. Deadline of registration is on August 31.
Each team must have Team Banner and Guidon for recognition and they must be prepared by the organizers. They will be fitted to a weighted loaded stick.
Once the Team Banner and Guidon are folded, destroyed, or lowered below head level automatically disqualifies the team.
Laban ng Lahi 2018 is the brainchild of Joenel Pogoy, founder and president of Camboayan Sports Event Management and a member of Philippine Military Academy Class of 1999.
Pogoy, who is a native of La Union, Cabadbaran City, Agusan Del Norte, conceptualized the event as a way of uniting the country through sports and promote it globally.
“My inspiration is faith in God, who gave me the wisdom,” said Pogoy, who also revealed some challenges he encountered while organizing the event, including people who did not believe in his advocacy.
First launched last March 2017, the event did not push through supposedly on September that year because the original financiers abandoned the project, taking with them the first advertisement cash sponsorship worth P1 million.
“I have no choice but to postpone the finals event but I continued the qualifying leg in Tanjay, Negros Oriental for the purpose of actually introducing the competition concept. Secondly, I cannot just retract my commitment to the Mayor of Tanjay City regarding this qualifying leg project because it was already included in their calendar of activities during their month-long fiesta celebration,” Pogoy said.
Eventually, his persistence paid off and re-launched the project again this year and got the support of no less than Boxing champ and Senator Emmanuel “Manny” Pacquiao, who will be coming to Cabadbaran City as a team runner-member of Saranggani Gladiators Platoon.
Apart from Pacquiao, Fifth District of Pangasinan Rep. Amado T. Espino, Baguio City Mayor Mauricio G. Domogan, Zarraga, Iloilo Mayor John Tarrosa, ABAKADA and ABS Partylist also expressed their support by endorsing the event and hosting the qualifying legs.
“I am enjoining all local government leaders as well as the Filipino communities all over the country and around the world to send competitive teams from your respective area,” said Pacquiao in a statement.
The event is sponsored by Summit Drinking Water, Maharlika Pilipinas Basketball League (MPBL), Du Ek Sam (DES) Inc., SM City Cebu, Shangri-la Mactan Resort & Spa, Wellcome Hotel Cebu, Quest Hotel, Silent Option Security, Podium Boutique Hotel Baguio, Ebays Coffee Shop, Nardas, Palcer Place Travel & Tours, Asianskymall, Asian Massage, Kyusoku Bihaku, Ikumou Hair Grower Shampoo, Diamond Q Security Agency, Yellow Kids Talent Center, and Flexgear Philippines.
If there are things that keep 39-year-old Marie Anne Concepcion-Magpantay from giving up, it’s her untiring faith in God and unwavering support of her family and friends.
Meanne (as she’s more fondly called) has been diagnosed with Myelodysplastic Syndromes (MDS), categorized as refractory cytopenia with multilineage dysplasia 2 percent blast in February 2016.
It started with a feeling of dizziness, which she thought at first was slight anemia because her hemoglobin levels were always low. But after a bone marrow biopsy at the National Kidney and Transplant Institute (NKTI), her hematologist finally told her she’s suffering from MDS.
Her ‘old’ lifestyle
A second child to a family of four, Meanne was born to a very religious but humble and supportive family. While parents provided her a very good comfortable life, sent her to a good school where she spent most of her happy childhood and student years, she was taught how to become responsible and hardworking to support herself and her family.
“I’m workaholic. I used to stay up late. My work stressed me out because I used to handle payroll and company benefits so I don’t go home until it’s done,” Meanne said.
She used to work long hours in a multinational automotive manufacturing company for 15 years as a human resource associate. She would leave the house as early as 5 a.m. and goes home at 10 p.m.
When she was 18 years old, Meanne suffered endometriosis, a painful disorder in which tissue that normally lines the inside of the uterus – the endometrium – grows outside of the uterus.
She would experience heavy bleeding during periods and her periods would usually last longer than five days to a week.
Studies show about one-third of women with endometriosis have trouble with fertility and struggle to get pregnant.
Married on September 17, 2005, Meanne and husband wanted to have her ovaries removed, but after seeking medical advices from several obstetricians, they all advised otherwise and confirmed that it’s not her ovaries that are causing the fast dropping of her hemoglobin levels so it’s safe to conceive a baby.
Surprisingly after a year of marriage in 2006, Meanne and husband finally conceived a “healthy” baby, but a week before delivery, the baby died inside her womb.
The couple wanted to know the reason why, but since autopsies usually take two to four hours to perform, preliminary results can be released in 24 hours, and the full results may take up to six weeks to prepare, they didn’t push through with it.
It wasn’t until after she was diagnosed with MDS in 2016 when Meanne finally concluded that maybe her condition has something to do with her child’s death inside her womb 10 years ago.
Type of cancer
A fact sheet published by the American Cancer Society explained that MDS is group of cancers in which immature blood cells in the bone marrow do not mature and therefore do not become healthy blood cells.
Some cases are mild, while others are more severe, and carry a high risk of becoming acute myelogenous leukemia (AML).
Supportive care for MDS patients include transfusion of red blood cells (RBCs) that are deficient and treatment of infections.
Apart from blood transfusions, Meanne started receiving oral chemo, which costed her P15,000 per 30 tablets (or one cycle). But after two cycles, she sought a new hematologist and chemo drugs.
Unfortunately, iron deficiency is a common complication in cancer patients so Meanne had to undergo iron therapy which costs P10,000 per session to restore iron balance in her body.
Last year, she was diagnosed with yet another illness, Bartter Syndrome, a condition caused by a defect in the kidneys’ ability to reabsorb sodium and she is losing too much sodium through urine.
Alongside with her MDS, she was also diagnosed with a congenital heart disease and now she’s also having complications with her lungs. Apparently, her lungs are retaining fluids that need to be drained once in a while, which explains why she always looks bloated.
Her doctors call her “living miracle” for surviving her condition and its many complications, but they worry because she has already received 190 bags of blood. Some of their patients usually have only 100 bags and die after.
Blood transfusions can be lifesaving according to studies. However, it’s important that the blood is accurately matched to patient’s blood type. If not, they can be harmful to her kidneys and lungs, or can have serious reactions to the immune system.
And while doctors don’t limit the number of blood transfusions over a person’s lifetime, having to get that many bloods can result to greater risk for side effects.
Support and maintenance
It’s been two years of struggling financially, emotionally, and mentally for being in and out of the hospital, transfusions there and there, but instead of improving, Meanne’s case is progressing.
“All in all, we’ve already spent more than P2 million for my hospitalization, medications, and confinement,” Meanne revealed.
At present, Meanne relies on different charitable institutions to sustain her medications and hospital confinements like Department of Health, Philippine Charity Sweepstakes Office, Department of Social Welfare and Development, friends, family, and anonymous people.
“I try to be strong. People praise me for being strong based on what they see on Facebook, but honestly deep inside, I’m really in pain. I want to give up. I just try to be okay,” revealed Meanne as tears flow down her cheeks.
Apparently, Meanne’s doctors admitted that her case is already aggressive. Her hemoglobin levels are dropping so fast not to mention her many complications.
“They [doctors] advised us to seek second or better opinion. My doctor almost gave me up. She told me, ‘If there’s someone better than me, it’s okay if you find another. I’m really having a hard time on your case’,” Meanne added.
If she used to undergo blood transfusions after two or three months before, now the intervals are shortened to one or two weeks. From eight bags, she already reached 10-13 bags per session.
“Time is important to me. When I leave the hospital, I cannot lay in bed or stay at home all day. I do everything I can to make me happy. I try to look my best,” she said.
While she believes in miracles and that she knows she’ll get better soon, Meanne couldn’t help but question God.
“Why me? I’m at the peak of my career, earning a living. I’m at the stage where I’m supposed to be enjoying my life, exploring. I’m just starting to explore. I gave up so many things – my friends. I don’t go out with them anymore, they visit me at home,” Meanne said.
She also lamented at how some of her “friends” only know her when she had money, but now doesn’t know her anymore.
“You know it’s really hard to ask people for help, because I’m not used to it. I used to have a job. I was the one giving, not receiving. But now it’s different when you’re the one asking for help. It hurts.”
“But it’s okay. You will know who your real friends are in difficult times. But there are also those people who didn’t really give up on me. Those friends I don’t really get to see, but they’ve been supporting me financially and offering prayers. I realized many people still love me.”
How to deal with sick patients
Studies show that patients with chronic or life-threatening disease can easily become depressed and anxious about their health circumstances.
They may have symptoms of depression: feeling helpless, hopeless, isolated, worthless, and overwhelmed. They also deal with problems with anger and interpersonal relations, or loss of interest.
Knowing how to offer comfort and support to a loved one can be challenging. Doctors advise family or relatives to let their sick loved ones know that they are willing to listen to his or her concerns. Don’t underestimate the value of your presence.
“Even it feels as if you’re not doing anything, your presence sends an important message. Don’t, however, try to be a counselor,” said an article published by the Mayo Clinic.
At present, Meanne lives with her parents and younger siblings to find comfort while recovering.
“Sometimes I’m happy. I feel blessed and grateful. But there are times, I wake up one day and think I’m getting crazy. They don’t understand, even I don’t understand myself. I cannot control my emotions, partly because I’m in pain. I’m super sensitive maybe because of the blood reactions in my body. Sometimes, I’m slow in comprehension. I also find myself disoriented. Sometimes I don’t remember my age anymore. At my worst, I just sleep and vomit and don’t want to talk to anybody.” Meanne admitted.
One day, when she finally finds herself better, Meanne vows to go back to church and serve God. She will testify how God healed her and helped her through it all.
“That’s what’s missing in my life. Just like the prodigal daughter [in the Bible], I want to go back to Him. Honestly, I almost lost my faith when I got sick. I’m not perfect. Nobody’s perfect, but why me Lord? But just the thought that I’m the one who’s sick and not any of my family, I’m [already] okay with that,” she said.
Looking back, Meanne only wanted a simple life, a healthy and happy family, a stable job until she retires that can help her family and other people. But now she’s sick, she can only advise other patients not to lose hope, pray, and always believe in what God can do.
“Miracles happen all the time. We don’t own our life, we don’t know when we are going to die, even healthy people can die anytime. Even if you’re sick, try to be a blessing to other people and become an inspiration to other people that life is still good and God is present in our lives. I’m still thankful, I’m still alive. I’m a living miracle. With God all things are possible,” she said.
For those who would like to help, any amount of donation would be sincerely appreciated. Please deposit to: Marie Anne Magpantay (Metro Bank: 020 3020 193094, BPI Family Bank: 005843 1945 77, or Western Union: Marie Anne Magpantay).
Easier said than done for hospitals to disclose a medical error committed by one of its surgeons or nurses, but one doctor suggested that it is one of the many ways, including the use of a surgical checklist, to ensure patient’s safety.
Then 60-year-old Pelaprina Sanchez-Carorasan knew something wasn’t right days after she left the hospital for a cyst removal in her hip area. She recalled that after surgery and even after finding out from the results of the biopsy that her cyst was benign, instead of recovery, her condition worsened.
She started feeling unwell, was in constant pain, and her hip area grew swollen. She tried seeking different doctors’ help, including a quack doctor, but they all failed to explain and find cure for her lingering illness.
Months and years that followed, her surgical wound remained open, became watery and infected that left her bedridden for years.
It took her 10 years to feel a strange, itchy object in her hip area. When she scratched it and slowly pulled out an unidentified object, she discovered a piece of rotten gauze coming out from the wound area.
Pelaprina decided to go to the hospital to show the gauze and upon the doctor’s advice, she tried to locate the doctor who performed her cyst removal to formally sue him, however, after confrontation denied his hand on it, saying he cannot be blamed for something that had happened 10 years ago as there might have been other factors that affected or caused her condition.
It’s been more than 25 years since that medical negligence that changed the life of Pelaprina, who is now 85 years old, but she has managed to stay well and healthy, has even traveled to Sydney, Australia many times and visited different places within the country by the grace of God.
Medical negligence, errors
The World Alliance for Patient’s Safety in 2015 reported that there are 63 million traumatic surgeries, 10 million pregnancy-related surgeries, and 31 million major surgeries being performed worldwide annually.
Apparently, complications after in-patient operations occur in up to 25 percent, crude mortality rate after major surgery is 0.5 to 5 percent, and in industrialized countries, nearly half of all adverse lists in hospitalized patients are related to surgical care.
“At last half of the cases in which surgery led to harm are considered preventable and known principles of surgical safety are inconsistently applied even in the most sophisticated setting,” said medical doctor Maximo Simbulan, past president of the Philippine College of Surgeons and founding chair of ASEAN Federation of Surgical Colleges.
Simbulan added that the stages of surgical care are not a one-time thing. It is a process and a journey where the patient starts from the preoperative preparation (the diagnosis or identifying of disease), intraoperative (technical expertise of the surgical team), post-operative care, and the follow-up of the disease.
“When we are talking about surgical safety, it is really the continuum that starts even before the patient enters the hospital. It starts with the first time you see a patient in the clinic, and it will end until the patient has fully recovered and has visited you for the last time,” said medical doctor Alejandro Dizon, president of the Philippine College of Surgeons.
Dizon revealed that the issue on surgical or patient’s safety as a whole is not really new.
As early as 1917, there had been advocacies on how to address this by primarily looking at results, best practices, bad results, and even asking hospitals to bring it out on public and compare it for the interest of making it better for the patients, but people view it as a radical thinking and wasn’t warmly received that time.
The attention to patient’s safety really started, in what was called the patient’s safety movement, because of a landmark publication in 1999 by the Institute of Medicine in the United States, “To Err is Human”, which brought to the public for the first time the true impact of medical harm and error.
“Each year, 44,000 to 98,000 people die in US hospitals not because of their diseases, but as a result of preventable medical errors. The thing is, it’s not about people, it’s not about the people that is the cause, but unfortunately, they are typically blamed especially the ones closest to the incident, but it is because of a faulty system that allows a person to commit a mistake,” Dizon said.
Medical errors is defined as the “failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim”.
The errors that can lead to death range from surgical complications that go unrecognized to mix-ups with the doses or types of medication patients receive and can cost about $17 billion to $29 billion per year in hospitals in the US.
Dizon shared methods that are currently being employed by St. Luke’s Medical Center – Quezon City to ensure that less post-surgical complications occur, to push for the bigger goal of patient safety.
He explained and stressed the need for a “checklist” prior to surgery, which covers the essential items for a smooth procedure.
A great example of this, he said, is the World Health Organization Safety Checklist, which covers three phases: the period prior to induction of anesthesia, the period after induction and before surgical incision, and the period during or immediately after wound closure.
Confirmation of the completion of tasks per phase is necessary before the procedure moves onward.
“It’s easy to blame a nurse who mistakenly administered the wrong medicine or gave multiple doses and tell her it’s her fault. You can [easily] suspend or kick her out. But when you do an in-depth investigation, not focusing on the person, but on the system, it is important to know, what allowed that nurse to commit that mistake?” Dizon emphasized.
Dizon suggested looking at some factors such as the environment, area of medication and preparation, the lighting, even the small writings at the medicine bottles.
Maybe the nurse wasn’t able to read the instructions properly or maybe she was in a hurry to go home and turn over her duties to another duty nurse that time.
“Those are the things that you need to look at. How do you make the work of a nurse better? Some wear a vest when preparing medications that says: ‘Do Not Interrupt Me, I’m preparing a medication’. Or you can enhance the workplace where the nurses are preparing medicines. That’s one example of a simple solution or ways to overcome human errors,” Dizon suggested.
Medical doctor Erlinda Oracion, who is the clinical quality director of The Medical City and member of the Philippine Society of Anesthesiologists (PSA), and Philippine representative to the Safety and Quality of Practice Committee of the World Federation, echoed the need for more consistent usage of the surgical checklist, and potentially building comprehensive guidelines for high volume procedures to help focus on successful patient outcomes.
Together with fellow PSA member, medical doctor Claudia Rafanan, chairman of the Anesthesia Department of Cebu’s Chong Hua Hospital, Oracion highlighted the importance of responsible use of anesthesia, a drug that causes insensitivity to pain, which allows for a more controlled environment that benefits both the patient and the doctor during surgical procedures.
Rafanan afterward shared current practices that have helped the Chong Hua Hospital become an example for other medical center who desire to give their patients the safest and best care possible.
She expounded further on anaesthesia, and the right use of muscle relaxants and reversal agents that significantly helped lessen surgical risks during high volume cases such as abdominal procedures.
“Surgery should be safe – period. This is the operative environment that patients deserve. Hence, it is essential that surgery is guided by modern safety principles, open communication, as well as a multi-stakeholder cooperation,” said Maria Fatima Garcia-Lorenzo, president of the Philippine Alliance of Patient Organization (PAPO).
Disclosure is key
“Bottomline is transparency. Because in the end, knowing that it is happening, [then] we have to do something about it. It all boils down to culture. That’s part of the culture – culture of reporting, a culture that encourages one to be brave enough to share,” Dizon said, who shared an incident where they commended a nurse for his admission of a medical error.
Upon inventory of medicines, the nurse discovered on his own that he mistakenly gave a patient a multiple dose. When he told the doctors about it, the nurse broke down to tears because instead of being punished, he commended for being honest and telling them about it, at least they can still do something about it.
Luckily enough for the nurse, the patient was left unharmed.
Dizon admitted it is not easy for the hospital to admit when things go wrong, but that’s part of it. The hospital staff has to acknowledge there’s something wrong and assure the patient and his family that they will work on it or are working on it.
“By that approach, we were able to minimize litigations. Sometimes, we have to settle because it’s our fault. But rather than having a long-dragging case in court, 10 years is too short, we are more proactive. But then it is easier said than done. It’s not that easy. We try if we can,” Dizon said.
He revealed that their hospital policy is disclosure, but there’s a way of doing it. There should be a sit-down discussion with the patient to let them know, and it should involve the top leadership, particularly the medical director.
“Acknowledge, apologize, and look into it. Many times, it proved successful and many times it doesn’t,” Dizon said.
To commemorate this year’s World No Tobacco Day, about 200 runners from different universities and communities recently gathered for a fun run in the Cuneta Astrodome in Pasay City to appeal to the Senators to pass the pending bills to raise tobacco tax.
“We believe that World No Tobacco Day is the perfect avenue to campaign for the immediate passage of the tobacco tax bills filed in the senate. Today, we run away from the harms of smoking and actively campaign for better health conditions in the country,” said Austin Angeles from the Pamantasan ng Lungsod ng Maynila (PLM) and head of the fun run organizing committee of the Youth for Sin Tax Coalition.
After an almost three-kilometer run, the young anti-smoking advocates from the Pamantasan ng Lungsod ng Maynila, Philippine Normal University, Polytechnic University of the Philippines, University of the Philippines and health advocates from different parts of Metro Manila, held a short program on the Senate grounds appealing to Senator Sonny Angara, chair of the Senate Committee on Ways and Means to conduct hearings on the pending bills of Sen. JV Ejercito and Sen. Manny Pacquiao.
After the program, representatives of the runners talked to Sen. Ejercito inside the Senate building to give him a copy of the advocates’ statement.
He said he supports the increase in tobacco tax rate, especially because revenues are needed to fund the universal health care (UHC) program.
Meanwhile, in his speech at the forum, Health for Juan & Juana: Moving Forward with the Philippine Health Agenda held in Philippine International Convention Center on Tuesday, Ejercito expressed disappointment that a measly increase of PHP 2.50 in the excise tax imposed on cigarettes was included in the Tax Reform for Acceleration and Inclusion (TRAIN) law last year instead of his proposal to increase the tax rate by PHP 90 pesos per pack.
Ejercito said significantly raising tobacco tax rates is key in fully implementing the UHC program, which he proposes to legislate.
“The financing aspect could make or break the UHC as a landmark legislation. The biggest question that we should be asking now is where we are sourcing out the funds needed to finance UHC. This was the intention when I filed Senate Bill 1605 to increase the excise tax on tobacco products,” Ejercito explained.
Aside from Ejercito’s Senate Bill 1605, Senate Bill 1599 by Sen. Manny Pacquiao also pushed the increase of excise tax on cigarettes to P60 per pack.
“Our estimates show that we can raise at least P67 billion more if either of the current Senate Bills were passed. This is possible, as we have already seen how increases in tobacco and alcohol taxes had more than quadrupled the country’s health budget from P42 billion in 2012 to P171 billion in 2018,” said Jo-Ann Diosana, Fiscal Policy Reforms team head of Action for Economic Reforms (AER).
Smoking and heart disease
Every year, on May 31, World Health Organization and partners mark World No Tobacco Day (WNTD), with this year’s theme: “Tobacco Breaks Hearts”.
The campaign focused on the impact of tobacco on the cardiovascular health of people worldwide.
Globally, tobacco use and exposure to secondhand smoke contribute to approximately 12 percent of all heart disease deaths, as data from World Health Organization showed.
“I would like to reiterate that tobacco use and breathing secondhand smoke may indeed break your heart. You may have heard of this, a million times, smoking is dangerous to your health, but we still want to remind you every time we have a chance. Tobacco smoke thickens the blood, increases the risk of blood clots, narrows the arteries and restricts oxygen in the blood,” said Health Secretary Francisco T. Duque III in a press statement.
In the Philippines, one out of four adults still smoke. This puts them at risk of non-communicable diseases, including cardiovascular diseases like heart attack and stroke. Around four Filipinos die every hour from tobacco-related heart diseases.
Also in the country, ischemic heart diseases or the “hardening of arteries” continue to be the leading cause of death with more than 74,000 cases recorded in 2016.
Moreover, the Philippine Statistics Authority listed five other non-communicable diseases linked to smoking as top causes of deaths and diseases among Filipinos namely, cancer, stroke, hypertension, diabetes mellitus, other heart diseases. These are known to be strongly linked to four risks factors, one of which is tobacco use.
The health chief further advised current smokers to quit smoking and seek help through phone-supported tobacco cessation called Quitline. Launched last year, Quitline (165-364) provides real-time counselling and support.
“With the Quitline, Filipino smokers now have an easier, accessible way to put into action their intention to quit smoking,” said Duque.
He also highlighted the importance of smoke-free environments that prevent smoking uptake among non-smokers and promotes quitting among current tobacco users and encouraged the youth to make informed decision and keep away from initiating tobacco use.
“We call upon our youth to make informed decisions and make smart use of technology. With abundance of information available in the web, we hope everyone gets the right content from credible sources,” said Duque.
According to the Tobacco Free Initiative’s Factsheet about health benefits of smoking cessation when an individual quits smoking, within 20 minutes his heart rate and blood pressure drops.
Within 12 hours, the carbon monoxide level in the blood drops to normal and within a year, if the smoker ceases to use tobacco, his risk of coronary heart diseases reduces to about half compared to a current smoker.
In five years, stroke risk is reduced to that of non-smoker.
Even with the set of knowledge and skills acquired from his profession, medical doctor Erric Cinco was not able to escape the wrath of hypertension that runs in his family.
Cinco, his cousin (who’s not even in his 30s), and the rest of his family members are all hypertensive.
“There is a strong genetic tendency for hypertension. The good news is, knowing my family history, I was very vigilant. I monitor my blood pressure so mine’s controlled. I always take my blood pressure. I didn’t wait for the symptom,” said he said.
Cinco debunked the myth that experiencing pain in the nape tells if a person is hypertensive.
“That’s not true. That’s minority. The majority of hypertensive has no symptoms. It’s a silent killer,” said Cinco. “If you cannot take a temperature, you can never detect a fever. You cannot detect hypertension, if you cannot take your blood pressure,” said Cinco.
The thing called ‘hypertension’
“High blood pressure is a silent killer. It is the No. 1 contributing risk factor for global death, causing many cardiovascular complications,” said medical doctor Alberto Atilano, president of the Philippine Society of Hypertension (PSH).
Medical doctor Jorge Sison, president of Philippine Heart Association, defined blood pressure as the force exerted by the blood against the inner walls of the blood vessels.
“Hypertension is elevated blood pressure above 140/90 mmHg,” said Sison.
In the Philippines, high blood pressure remains to be a growing health concern. In the Presyon 3 Target Organ Survey–Philippine Heart Association Council on Hypertension National Survey on Hypertension data published in 2013, it found that one out of every three to four adult Filipinos, 18 years old and above, is hypertensive.
Although awareness and treatment among these hypertensive patients are high, only one in every four treated individuals have controlled blood pressure.
“In the Philippines, only 27 percent are controlled or protected, the remaining 73 percent are at risk of organ damage. What we want is at least 80 percent,” said Sison.
In a National Health and Nutrition Examination Survey (NHES) in 2017, it reported the Philippines is not alone. Even in other Asian countries, hypertension or uncontrolled blood pressure is a problem.
In Pakistan, only 5.5 percent of the hypertensive have good blood pressure, 10.7 percent (rural) and 20.2 percent (urban) in India, 13.8 percent in China, 25.8 percent in Hong Kong, 26.3 percent in Malaysia, 31.7 percent (men) and 42 percent (women) in Japan, and 36.9 percent (men) and 49.4 (women) in Korea.
The highest percentage of controlled BP was recorded in Taiwan at 70.2, followed by Singapore at 69.1, and 60.4 in Taiwan.
Globally, hypertension is the leading cause of death.
“It doesn’t spare anyone whether you belong to a high, middle, or low socio-economic status, you’re not immune. Everyone is vulnerable to having hypertension,” said Sison.
Hypertension is the major cardiovascular risk factor. If left untreated, it can lead to progressive organ (kidney, heart, brain, blood vessels, including the eye) damage, clinical signs of disease, and life-threatening cardiovascular events.
“I have some patients who went blind because of uncontrolled high blood pressure. Age is also a risk factor. As we grow older, we develop increased resistance in our blood vessel because of arteriosclerosis, aging, etc. Blood pressure goes with age as well,” Sison added.
The risk factors for hypertension include family history, advanced age, overweight and obesity, diet (especially excess salt), lack of physical activity, smoking, too much alcohol, drug intake, and other diseases (kidney, renal, or endocrine).
Presyon 3 data also found that 40 percent of people with high blood pressure have a family history from either the father, mother, grandparents, and other relatives.
“Hypertension has two sources: there’s modifiable and non-modifiable risk factors. Non-modifiable, you were born with it, it’s in your genes. High blood runs in the family, we cannot do anything about it. But there are modifiable risk factors such as lack of exercise, poor diet, and you can change that.” Cinco said.
Focus on home BP monitoring
HOPE Asia (Hypertension Cardiovascular Outcome Prevention and Evidence in Asia) Network, which consists of 20 expert members in Asia, emphasizes the need to monitor blood pressure at home using electronic or digital gadgets.
“Home is where the heart is. We would like you to monitor yourself at home, not just monitoring your Facebook, text messages every day. You also have to watch your blood pressure. That’s what I tell my patients when they come to see me for a check-up, check your blood pressure at home. It matters a lot more than anything rather than just relying on blood pressure gadgets in my clinic,” said Sison.
“If you’re at home, normal BP is 135/85. In the clinic, it’s higher because there are factors like hospital environment, doctors, nurses, or what we call the ‘white coat hypertension’ that affects the BP. If you have 135/85 BP at home, you are hypertensive.”
Sison, however, emphasized that there are conditions that must be met when taking blood pressure at home and not just sitting down.
“Before BP measurement, you cannot smoke or drink coffee for 30 minutes, no exercise for 30 minutes, and rest for at least two minutes, avoid eating, and empty bladder. When using HBPM [home blood pressure monitoring], BP is to be measured at the same time in the morning and evening for five to seven days. Overall home value equals the average of BP values over five to seven-day monitoring period,” said Sison.
Studies have shown that HBPM is able to predict occurrence of possible complications than clinic BP, increases in BP levels in morning, as measured by HBBPM, is better able to predict prognosis than clinic BP.
“To get an accurate BP reading, one should get correct cuff size, refrain from talking, back/feet are supported, legs uncrossed, arms at heart level, and cuff on bare arm,” said Sison.
“Lifestyle change is a big contributor in proper BP control. Unfortunately, success rate of lifestyle change alone is 15 percent. It’s difficult to depend on lifestyle. There are medicines on that, but when you don’t have means to buy them?” said Atilano, adding that the Department of Health gives free medicines in barangay (village) health centers.
Although there are issues in the efficacy with some medicines, Atilano said it is better than not taking at all for the reason that they cannot afford to buy them.
In line with the PSH participation in the global initiative called May Measurement Month, which is spearheaded by the International Society of Hypertension, Atilano shared how the local society is reaching out to all Filipinos to encourage screening for hypertension.
“We are very active on this. We have hypertension caravan for the lay people all over the country, and seminars for the doctors. Working together, we will realize our objective to improve awareness and control high BP,” said Atilano.
Atilano shared that the Philippines is one of the global leaders, and the No. 1 contributor with 271,604 surveyed data (22.6 percent of the global pool of 1.2 million) in a global cross-section survey participated by 97 countries in 2017.
“Globally, 34 percent were screened to be hypertensive, 17.3 percent are hypertensive but not receiving treatment, and 46.3 percent receive treatment but with uncontrolled BP,” said Atilano.
The study is the largest ever synchronized, standardized multinational screening survey of any cardiovascular risk factor and it allows exploration of potential associations between BP levels and other environmental factors including day of the week, and other participant characteristics (comorbidities, lifestyle).
Monette Ho, 39 years old, tried ketogenic diet or ‘keto’ to lose weight. Her normal weight is 120-128 lbs. before giving birth to her third and youngest son, but since then, she never regained her ideal weight.
Monette started keto diet last September 2017, but she had to stop after three months during Christmas break because she can’t follow a strict diet and can’t avoid drinking alcohol.
“I lost 20 lbs. from keto diet. I only did keto from Monday to Thursday, but I stopped it already, because I drink beer with my husband on a Friday or Saturday night – that’s our bonding/date night. We want to eat ‘normal’ food and drink beer,” she admitted.
“But I recommend it to people who can follow a strict diet. It has good benefits and you will really lose weight. In one week, I’ve known people from our Facebook group who lost 10 to 15 lbs. It’s hard to believe, but it’s really true. It is super effective. You just need to eat fats, but you cannot drink alcohol, which we really can’t live without so we switched to a no-carb diet,” Monette shared.
Since she started with a no-carb diet, Monette already lost 11 pounds. It’s a small progress, she says, but at least the diet is working for her and it’s not very strict compared to keto.
Some famous international celebrities who are into keto include Halle Berry, Vanessa Hudgens, Megan Fox, Kourtney Kardashian, and Adriana Lima.
Locally, there’s beauty queen Ruffa Gutierrez, singer-host Billy Crawford, and the heavy weight anti-corruption advocate, Juana Change who lost 192 lbs. from a staggering weight of 275 lbs.
Just like any diet, if it worked for some people, it doesn’t automatically mean it’ll work for everybody.
You see every year, people jump on the latest diet bandwagon or trend out of curiosity. Monette’s story is just one of the many stories of people who’ve tried a new diet, hoping they can keep it and it’ll work for them.
What is keto diet?
“A ketogenic diet or ‘keto’ is a high-fat but very low-carbohydrate diet, as low as 30 grams of carbohydrates per day or even less. In a way, a keto diet may be similar to a crash diet with extreme restriction of carbohydrate intake,” said medical doctor Rafael Castillo, member of Executive Council of the International Society of Hypertension (ISH) based in United Kingdom and Chairman, Communications Committee, ISH, said in an article published online.
Keto diet originated as a tool for treating neurological diseases such as epilepsy. Numerous studies show that this type of diet can help one from losing weight, controlling blood sugar, increasing mental performance, energy and normalized hunger, managing cholesterol and blood pressure, and insulin resistance.
It may even have benefits against heart disease, cancer, Alzheimer’s disease, epilepsy, Parkinson’s disease, polycystic ovary syndrome, brain injuries, and acne.
Studies show that keto naturally lowers blood sugar levels due to the types of foods a person eats. It is also more effective way to manage and prevent diabetes compared to low-calorie diets.
“It may be recommended, but it still requires some medical supervision, particularly in more senior adults, those with diabetes and other metabolic problems, and those who can’t stay away from alcohol once in a while,” Castillo warned.
He explained that patients with diabetes mellitus can benefit from keto. With less carbohydrates to metabolize, there’s a lower demand of the body for insulin.
Although some doctors treating young patients with type 1 diabetes (juvenile onset) say it’s safe for them, Castillo doesn’t recommend it for type 1 diabetics because of their higher risk of developing ketoacidosis, a serious complication of diabetes that occurs when one’s body produces high levels of blood acids called ketones, compared to those with type 2 diabetes (adult-onset).
Type 1 diabetics should be monitored by their physicians if they’re on keto diet.
What to eat
People confuse keto with high carb, high fat diets, which are terrible for the body. If one eats a lot of fatty foods that are high in sugar, he can get himself into trouble.
Majority of one’s meal should be based around meat, fatty fish, eggs, butter and cream, cheese, nuts and seeds, healthy oils, avocados, low-carb veggies, and condiments.
Any food that is high in carbs should be limited: Sugary foods (e.g. soda, fruit juices), grains or starches (e.g. rice or pasta), fruits, beans or legumes, root vegetables and tubers, low-fat or diet products, some condiments or sauces, unhealthy fat, sugar-free diet foods, and alcohol.
Due to its carb content, many alcoholic beverages can throw one out of ketosis.
Common side effects
Most people experience “keto-flu”, also known as ‘carb flu’, a natural reaction (almost like a feeling of withdrawal) when a body undergoes switching from burning glucose (sugar) to burning fat instead, but it often goes away after a few days.
As one’s body adjusts or adapts to changes, he may feel slight discomfort including headaches, nausea, fatigue, cramps, dizziness and aggravation, mental fogginess in the first week as a result of one’s electrolytes being flushed out.
One’s body is used to the simple routine of breaking down carbohydrates and using them as energy, instead the body shifts to burning fat, which produces an energy source known as ketones.
“This process is known as ketosis. So, people on ketogenic diets are in a state of ketosis. This is different from ketoacidosis, which can be potentially fatal. Ketoacidosis indicates an extremely high level of ketones, making the blood ‘acidic’ already. The three most common causes of ketoacidosis are alcohol, starvation and diabetes. And yes, it’s serious. It can cause death,” said Castillo.
While keto diet is great especially for people who are overweight, diabetic, or looking to improve their metabolic health, it is not for everyone and it needs medical supervision.
It is not recommended for elite athletes or those wishing to add muscles or weight. And time and again, any diet will only work if you are committed, consistent and you’ll stick to it in the long-term. Take things slow. Do it for yourself, not because someone else is pressuring you to do so.
It’s not unusual for depression and anxiety to occur in seemingly healthy young people, what more for a 60-plus-something-year-old patient who underwent major, life-changing health crises such as stroke or heart bypass surgery.
“About one-third of stroke survivors suffer from post-stroke depression (PSD) and it is strongly associated with adverse impact on cognitive function and functional recovery as well. Therefore, we should be aware of it, evaluate it, and treat it to prevent PSD,” said Prof. Nathan Bornstein, director of the Brain Division, Shaare-Zedek Medical Center and president of European Society of Neurosonology and Cerebral Hemodynamics (ESNCH).
Gone are the days when people would use the term ‘depressed’ as a simple and ordinary term to describe how bad his day was.
As the prevalence of depression rises throughout the country and in many parts of the world, more and more people are seeing it as a topic that needs more serious attention.
According to Dr. Rafael Castillo, member of Executive Council of the International Society of Hypertension (ISH) based in United Kingdom, cardiovascular causes remain the leading cause of deaths in the country and many parts of the world.
One out of three deaths are due to a cardiovascular cause, which includes coronary artery disease, heart failure, fatal arrhythmias, as well as strokes and other vascular causes.
Worldwide, stroke is the second leading cause of death. Moreover, the leading cause of global burden of disability, including long-term physical, cognitive, and emotional disabilities.
After stroke or surgery, it is normal to feel sad or worried, but if the patient feels sad, miserable, or down for weeks, he is already experiencing depression.
People with depression often find it hard to take care of their health. They also tend to eat poorly, get less exercise, and smoke, which can lead to a more serious health problem.
How to motivate elderly patients
“Essentially and partly, it is the responsibility of the medical care system. When we discharge patients from hospitals, we give them two sets of instructions: one for lifestyle and second for medications. I always start with the lifestyle, because if that started first, patients will see it as important. For bypass surgery patients, the surgeons are the most powerful people,” said Prof. Nanette K. Wenger, professor of medicine in the division of cardiology at the Emory University School of Medicine.
Wenger, who is also a consultant to the Emory Heart and Vascular Center and is listed in Best Doctors in America, has trained surgeons on what to do and say to their patients.
According to Bornstein, there is a proper way of telling patients to participate in lifestyle and activity programs so they won’t complain they don’t have the energy to do it.
“Tell them like you’re prescribing a drug. You have to take this medication [program/activity]. This is part of your recovery. You have to go to this program as if it was prescribed by your doctor. It’s not an option to take your medications, you have to do it,” said Bornstein.
Bornstein added that stroke and cardiac surgery are major events. There are lifestyle programs for post-traumatic stress disorder or post-event depression or medications such as anti-depressants that can be taken within three months or six months, depending on the doctors’ prescription.
“It is cultural and mentality. You have to persuade your patient that this is the way. If you have an authority to tell your parents to do that, that’s the way to go. It should be a structured program for them. Or if not, they can take medications that can also improve motor functions,” said Bornstein.
Role of psychiatric help
According to the World Health Organization (WHO), more than 100 million people suffer from mental disorders in the Western Pacific region, including in the Philippines; 5.3 percent of mental disorders in the region are depressive disorders.
In the Philippines, over 4.5 million cases of depression were reported in 2004 by the Department of Health. Globally, more than 300 million people are living with depression.
“The prevalence of psychiatric illness in human beings in the society is extraordinarily high. There is an article in the United States from the Center of Disease Control and Prevention on the prevalence of depression. It is something in the order of 20-percent of the US population suffers from clinically diagnosable depression. That’s huge – one in five people,” said Prof. Zachary T. Bloomgarden, clinical professor in medicine, endocrinology, diabetes, and bone disease.
Bloomgarden considers psychiatry as a medicine that all physicians need to talk to their patients where communication skills should be used to help people deal with these kinds of problems that affect all human beings.
“Some of the basic questions are, ‘Are you anxious? Are you depressed? Are you angry?’ But you cannot just say, ‘Are you depressed?’ because he will just say, ‘Oh no, I’m not depressed. I’m perfectly happy’ and he’ll go sit and watch television for 14 hours,” said Bloomgarden.
“Maybe it’s true that we need psychiatrists. But we also need clergymen. We need authors. One of the greatest ways to understand human emotions is to read the very thoughtful articles of the great novelists, which talk about these issues we all struggle with,” he added.
Importance of human relationships
Bloomgarden emphasized the need to respect the wishes of older people who wanted to be left alone or be independent.
“One problem in the United States is that our families are not often close. Older people lose contact with their children. People live in New York, while their children live in Los Angeles, Seattle, or wherever. We are forced to rely on trying to develop smart phone apps. Telephone is great but it’s not the same as [interaction with] human beings,” said Bloomgarden.
He further added, “If in the Philippines, you have extended families, cultural and religious ties, you might be far ahead, where we lost that. Keep doing what you have as a wonderful and warm people. It is important medically, in terms of maintaining the spiritual and emotional health of older and younger people, too.”
For those patients who are having a hard time engaging in physical activities, Wenger suggested water aerobics as the most fantastic physical activity.
“Just get into the water. You don’t even have to know how to swim,” said Wenger, adding that the preparation for a healthy lifestyle for a family should really begin when one is younger to avoid, prevent, delay serious health conditions.
Global medical experts Bloomgarden, Bornstein, and Wenger, who are more recognized as the “rock starts of the medical world”, were in the country as speakers of the fourth edition of the Experts’ Convergence for Health Outcomes (ECHO) Summit recently at the Marriot Convention Center.
Bloomgarden talked about, “Diabetes Care for the Older Patient: What are the Appropriate Goals?”, Bornstein delved on, “Optimizing Cognitive Recovery and Managing Behavioral Complications in Post-Stroke Treatment”, while Wenger discussed, “Geriatric Cardiology: Octogearian Pearls.
The event with this year’s theme: “Longevity and Quality of Life Matters” was attended by over a thousand Filipino doctors who gained fresh insights from these medical experts.
John Raven Bernarte or “Raven” (as he’s fondly called) always wanted to enter the seminary and become a priest.
Born to a family who regularly attends Sunday masses, Raven shared that as a kid, he’s always in awe whenever he saw priests wearing cassock or stole, celebrating mass, proclaiming the Good News, and teaching lay people about faith.
“I would dress like them. I would cut our curtains and turn them into a cassock-like garment. Sometimes I would wear big-sized t-shirts and pretend I was celebrating a mass in our house,” Raven recalled.
But life wasn’t all bed of roses for Raven and his family. He recalled how he almost died from dengue when he was a kid. The doctors even said he’s got only months to live, but with the grace of God, he survived. Then it was followed by his mother needing to undergo a surgery to get rid of an ovarian cyst.
“At an early age, I can already say I have carried crosses. But I didn’t mind the hardships that time because I have always believed what my parents would always tell me, it shall come to pass. With God’s mercy, we were able to surpass them all and looking back, those experiences made us stronger as a family and a follower of Christ,” said Raven.
In 2005, Raven’s mother decided to move from Quezon City to Rodriguez (formerly known as Montalban), Rizal for a house they bought for a cheaper price – a house they can finally call their own since they had no permanent house or address prior that time.
But at first, they were hesitant to live in Rizal due to its the distance, not knowing, this is where he will be called to serve.
In 2007, Raven joined the Ministry of Altar Servers at the Our Lady of the Most Holy Rosary Parish in Rodriguez, Rizal, but had to transfer to a nearby parish in San Rafael after a year due to parish restrictions, where the parishioner has to serve in a nearby parish where he lives.
In 2008, Raven graduated from Eulogio Amang Rodriguez Elementary School (ERES) and from Roosevelt College Rodriguez in 2012.
“As I serve in the parish, little by little, one thing is becoming clearer to me – I really wanted to enter the seminary, but my mother won’t allow me that time,” Raven admitted.
After High School, he took Bachelor’s degree in Secondary Education, a course his mother wanted him to take, at St. Joseph’s College in Rodriguez, Rizal, only to realize later that God used that education for him to grow the seeds of his desire to pursue his priestly vocation.
“My teachers, nuns, classmates became instruments for me to continue pursuing my vocation,” Raven said.
But in 2013, the desire to pursue his priestly vocation was sidetracked by his desire to help his family by availing of a free education to help himself graduate from college.
Upon his father’s encouragement, Raven took a cadetship exam, to which he passed, and entered as a plebe at the Philippine Military Academy in Baguio City on April 1, 2014.
Apart from the noble privilege of serving the country, being a PMA cadet entitles you to free college education with a well-rounded curriculum, monthly salary and allowances, guaranteed job after graduation, and a progressive career as an officer in any of your chosen branch of service: Philippine Army, Navy, or Air Force.
“But it’s hard to be a plebe, especially during Beast Barracks or Summer Camp – my two months in the academy. I developed a health issue so I had to undergo a surgery where I was recommended to rest for six months outside the academy.”
After six months, Raven was able to go back to the academy and when he’s back, he began excelling in his academics.
“I experienced a little comfort in life in PMA, because I got to buy my things from my hard-earned allowance, but my conscience and my heart always bugged me, especially whenever I think of what profession I should have in life,” Raven admitted. “I felt something is missing. I’m not completely happy.”
Life outside PMA
His lingering health issue was all it took to make him decide to really quit the academy for good, and went back to the parish serving as a member of an all-male choir.
“At first, I couldn’t accept it. I felt I was treated like a garbage just being thrown away. I couldn’t help but feel frustrated.”
Raven came to a point where he started doubting if there’s really a Christ and questioning if his life had been really worldly to deserve all the frustrations and disappointments.
“I went to mass and sang with the choir not because I was serving God, but because it became my weekly routine. But God had been really good to me, because he didn’t allow me to go astray. He used people to lead me to the right path.”
One-on-one with God
After one mass, he decided to visit the Adoration Chapel and to really talk to God – heart to heart. But before he entered the chapel, he was already teary eyed due to sadness, frustrations, pain, and remorse.
“I didn’t do anything in front of the altar, in front of Christ in the presence of the Holy Eucharist, but just cried and meditated. I felt too dirty. I felt too evil. I’m not the same Raven anymore.”
Raven felt really, really tired that time even though he wasn’t doing anything. All he remembered saying over and over again was, ‘Sorry, Lord’ and that’s when he finally decided to start fixing himself and surrender his life to God.
“On my part, He gave me everything I needed, but I’m still sad. It’s true what St. Thomas Aquinas said, ‘Only God can give us true happiness.”
The desire to serve Him came back to life and little by little, Raven started discovering the signs God had been sending him all those years through people and his life experiences to make him decide to pursue his vocation.
“I broke up with my girlfriend before entering the seminary. I won’t forget how I asked her if it was okay for her if I enter the seminary. It was her birthday and we were celebrating it together. And she replied, ‘If that’s what you really want and God wants it for you, I’ll accept it.”
Life in the seminary
It’s been a year now since Raven decided to enter the seminary, which coincided with the church’s celebration of Pentecost, or more popularly known as the church’s birthday or the coming of the Holy Spirit on the early followers of Jesus.
“For me, this time is the birth of my vocation as a priest – by being a seminarian.”
Raven recalled how worried he was after passing the entrance examinations in the seminary on how he was going to support his education given his family’s financial situation. It was also difficult to find a benefactor that time even with the help of a parish priest.
“I cried my worries to God. I told him, ‘Lord, if your will for me is to become a priest, I lift all my financial difficulties to you.”
The next day, a relative priest who hails from Albay called and wanted to see him. After talking, God must have answered all his prayers because that relative of his pledged to take care of all his financial worries. The rest is history.
“Why do I want to become a priest? I want to become a priest not because I want to just answer the call, or be famous or popular, I want to become priest because it is only through Him I felt the love I have never experienced from anyone before. Despite my weaknesses, sins, unfaithfulness, and lack of love for Him, He didn’t forsake me. He loved me, accepted me, and forgave me. I want to become a priest because I want to be a part of Christ’s mission. I want to be a priest and become an instrument of His love and mercy through His sacraments, especially during Holy Eucharist celebration and reconciliation. I want to be like the Good Shepherd that guides his lost and broken sheep back to Him. I want to become a priest because I want to be a living proof that proclaims, “Do not fear, He is alive and He is with us.” – John Raven Bernarte
Up to now, Raven still feel unworthy of his vocation, but who can say no to God when calls one to serve Him?
Not yet a priest though but a seminarian, Raven still has more years, struggles, hardships, pains, joys, and milestones to experience and endure for him to be ordained as a priest, but with our prayers and support of his family, friends, and parish community, I’m pretty positive he can surpass them all.
To Raven, may God bless and keep you in this journey. Good luck!
For more ABITO SERIES:
We all hope that our very own babies won’t get sick. But when a newborn baby is diagnosed with a life-threatening condition, no matter how early or late in pregnancy, it is already a loss that parents grieve.
For Aries and Chillet Cabildo, there’s nothing more heartbreaking than discovering that their only child, Asher Carlos, has a problematic heart.
They discovered Asher’s illness a week after he was born when they brought him to a well-baby check-up. The doctor heard a murmur in his heart so they were immediately referred to a pediatrician-cardiologist, who diagnosed Asher suffering from Tetralogy of Fallot.
While the doctor recommended Asher for surgery, the doctor advised them to wait until he turns one-year-old. So Chillet worries whenever Asher would experience shortness of breath while playing, and when he cries, his lips and face would turn bluish.
While they discovered his father’s illness five years before he died, he took his illness lightly by refusing to take regular medications because of financial difficulties and it was already too late for him to undergo a triple heart bypass surgery.
Chillet, 25, finished Chemistry in college and used to work as a clinic assistant. She had to give up work because of her delicate pregnancy and to take care of Asher full time. Aries, 29, works as a collector in a lending company and earns a minimum of P7,000 a month, so they really have no means to sustain Asher’s monthly medications and surgery.
Now that Asher turned one-year-old, the couple took their chance and visited a medical and dental mission hosted by Philippine Charity Sweepstakes Office (PCSO) in Cabanatuan City recently.
“Nagbakasakali lang kami na baka matulungan kami. Nag-try na kasi kami sa city hall dati kaso ni-refer din kami sa PCSO [We took a chance thinking maybe we could get help. We tried getting help from city hall but we were also referred to the PCSO],” Chillet said.
That’s when they met PCSO General Manager Alexander Balutan who was busy supervising the medical and dental mission at the time. They approached the retired Marine general who didn’t fail to give them hope and Asher a bright future.
Balutan assured them that the agency will maximize its financial assistance for his surgery up to his recovery.
According to Jose Bernardo Gochoco, medical services department manager at the Lung Center of the Philippines, the agency usually gives P100,000 worth of financial assistance (maximum) to a patient with heart cases but that would still vary on the case rate and patient’s classification.
At present, Asher has already been brought to the Philippine Heart Center in Quezon City with the assistance of PCSO to undergo various laboratory tests. They will have to wait for a week or two for the test results.
“If all goes well, there is a round of case conferences to determine the best management. Then if he is up for surgery, there will be another round of pre-operative clearances to be scheduled before it is finally done.
Afterwards, he will undergo post-operation recovery and rehabilitation if nothing goes wrong,” said Gochoco.
Tetralogy of Fallot
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease (CHD). It is also known as “tet.” The “ tetra” in the name of the condition comes from the four problems associated with it and the condition is named after medical doctor Etienne Fallot.
“The cardinal features associated with TOF are a hole between the right and left ventricles which is called Ventricular Septal Defect [VSD], narrowing of the pulmonary valve, which is called Pulmonary Stenosis [PS], aorta that has a shifted orientation and lays over the VSD [aortic dextroposition]and a thickening of the muscle of the right ventricle or right ventricular hypertrophy,” explained Maria Ronella Francisco-Mallari, pediatric cardiologist and active medical staff at the Makati Medical Center, Department of Pediatrics, Section of Cardiology.
The symptoms of TOF may be present at birth or shortly afterward. They include cyanosis (bluish discoloration of the skin caused by blood low in oxygen), shortness of breath, and rapid breathing especially during feeding or exercise, clubbing of fingers and toes (an abnormal, rounded shape of the nail bed), episodes of passing out or loss of consciousness, poor weight gain, and developmental delays or problems.
The tests that can aid in the diagnosis of TOF are echocardiogram, electrocardiogram, chest X- ray, pulse oximetry, and cardiac catheterization.
“A child with TOF might have sudden episodes of deep cyanosis called ‘hypercyanotic spells’ or ‘Tet spells’ that may occur during crying, feeding, defecating, awakening from naps, fevers, dehydration,” described Mallari.
Is TOF hereditary
According to Mallari, a CHD is a heart problem caused by abnormal formation of the heart during fetal development. In most cases, there is no identifiable cause for the heart defect.
As to the case of Asher, “The condition can be genetic [hereditary]. Although multi factorial inheritance has been postulated for the majority of cases, single gene transmission is suggested by the observation of disease recurrence within families, as in the case of Asher and his grandfather,” said Mallari.
Other than hereditary, studies have also shown that maternal abuse of alcohol during pregnancy, leading to fetal alcohol syndrome, is linked to TOF. In addition, mothers who take medications to control seizures and mothers with phenylketonuria are also likely to have a baby with TOF.
“Poor maternal nutrition, viral illness or genetic disorder might increase the risk of this condition, in most cases the cause of Tetralogy of Fallot is unknown. In the case at hand, a good maternal history should be done to elicit other contributory information,” added Mallari.
Treatments and complications
For treatments, Mallari suggested management of “hypercyanotic spells” or surgical repair.
Management of “hypercyanotic spells” include knee-chest position, which increases preload and increases systemic vascular resistance.
It also includes calming of the child (ideally having the child in family member’s lap), and oxygen supply (try to determine patients baseline saturating). Oxygen will decrease the pulmonary vascular resistance thereby increase blood flow to the lungs.
Morphine can also be used to calm and decrease tachypnea, sodium bicarbonate to correct any metabolic acidosis, if present, and propranolol, which is thought to decrease infundibular obstruction and decreases tachycardia leading to greater diastolic filling.
For surgical repair, Mallari said there’s complete intracardiac and temporary surgery, “Surgery is the only effective treatment for TOF.”
Complete intracardiac repair is an open-heart surgery, which involves several repairs: a patch is placed over the ventricular septal defect to close the hole between the right and left ventricles, the narrowed pulmonary valve is replaced or repaired, and the passageway between the right ventricle and the pulmonary arteries are widened to increase blood flow to the lungs,” explained Mallari.
Meanwhile, temporary surgery may be done if the baby was born prematurely or has pulmonary arteries that are underdeveloped or hypoplastic.
This is a palliative procedure where the surgeon creates a bypass (shunt) by placing a small tube between a large artery that branches off from the aorta and the pulmonary artery to improve blood flow to the lungs.
“When the baby is ready for intracardiac repair, the surgeon removes the shunt during the intracardiac repair,” said Mallari.
If left unmanaged or untreated, TOF can lead to complications such delayed growth and development, irregular heart rhythms, seizures, stroke, brain abscess, pulmonary embolism, sudden cardiac death, and bacterial endocarditis.
Article published at The Manila Times, May 4, 2018
From Dasmariñas City, Cavite, 28-year-old Jovie Mae Pelere, parent to two children, brought her youngest child to the Philippine General Hospital (PGH) in Manila to get her checked for an ailment because they couldn’t afford the expensive consultation fee in the nearby hospital.
“When we buy medicines outside, we are spending about P8,000. We are spending more for our medicines so we have cut off other necessary expenses at home,” said Pelere in Filipino.
Pelere and her husband don’t have their own home. They used to rent a home for P3,500 a month but since they cannot afford it anymore, they opted to stay in a neighbor’s house with their children.
Her husband travels far for work and his fare is expensive so they can’t even see a doctor for their children’s check-up.
When she had one kid, Pelere would go to a private hospital for check-ups. But now with two children, she has no choice but to go to a public hospital because it’s cheaper.
“We go to a health center before for a check-up, but they don’t know what to do to my child so they sent us to PGH,” lamented Pelere.
Pelere is just one of the many poor Filipinos who cannot even afford decent health care.
“It is high time we care for our patients to protect their well-being instead of just delaying their trip to the grave, so to speak. We need reforms in our healthcare delivery system that will focus on preventing ailments and promoting health aside from intervening when people are already sick. Curative care is important but can be more exacting on the resources of the government and of patients and their families, most especially,” said medical doctor Antonio Dans, head of Philippine Primary Care Studies.
For outpatient care
Philippine Primary Care Studies is a research group of the University of the Philippines that is helping the Department of Health (DOH), local government units, the Philippine Health Insurance Corp. (PhilHealth), and Congress to prioritize the strengthening of primary care systems as one of the key elements of Universal Health Care (UHC).
According to Dans, primary care in its simplest definition is “outpatient care”. This is where disease prevention takes place and where the focus of PhilHealth benefits should be to realize the goal of universal health care.
“Many patients do not have access to hospital facilities but can still go to outpatient facilities near them. Most diseases need outpatient care and not hospitalization. And even most patients who have been treated in a hospital would need outpatient care when they are discharged,” he explained.
While the current health system in the country works for some, this is does not represent the whole population. Many Filipinos still do not have access to health services despite the increase in the number of households getting covered by PhilHealth.
For the first quarter of 2018, the Philippine Charity Sweepstakes Office (PCSO) reported it already has 120,356 beneficiaries for its Individual Medical Assistance Program (IMAP), a 34-percent increase from the same period last year.
The agency also spent P2.35 billion, an increase of 40-percent from the same period last year.
“If you have PhilHealth, use it first. And if you have medical insurance or senior citizen’s discount, use it for your health care needs,” explained PCSO General Manager Alexander Balutan in Filipino.
To relive the patients from personal appearance in PCSO Main Office in Mandaluyong City or its extension office at the Lung Center of the Philippines in Quezon City, Balutan advised patients to go directly to 52 PCSO ASAP Desks located in partner-hospitals nationwide.
Aside from ASAP Desks, patients can also go to PCSO branches located nationwide.
“’The branches of PCSO has funds. In General Santos City, for example, the PCSO there has P350,000 per day, P50,000 of that is for Sultan Kudarat. Those funds are utilized everyday,” said Balutan in Filipino.
The Senate is currently tackling three bills on UHC: Senate Bill 1673 authored by Sen. Sonny Angara, Senate Bill 1458 filed by Sen. Joseph Victor Ejercito, and Senate Bill 1714 by Sen. Risa Hontiveros.
Upon approval, these bills intend to expand outpatient services to the full range of primary care for everyone, to include preventive and promotive health service, such as executive check-up and laboratory test.
The proposed strengthening of Philippine primary care systems, according to Dans, aims not only to provide all Filipino families with a primary care provider, but to link every Filipino with a local network of service providers designed and financed to take care of assigned populations.
The primary care provider will be the patients’ first point of contact in the health system and will be in charge of referring them to other health care providers in the service delivery network should they require more treatment.
This allows easier, more equitable access to essential health care needs such as check-ups, and lowers out-of-pocket spending for health care, as it prevents cases of Filipinos going straight to specialists and paying a higher than necessary price for treatment,” added Dans.
Article published at The Manila Times, April 28, 2018